ALTERNATIVES TO VCUG
There are several safe, available alternatives to VCUG. In a perfect world, any alternative that has been approved as safe and effective would be disclosed to parents as options for their child’s treatment under the informed consent doctrine. Sadly, caregivers can’t count on this courtesy.
Most hospitals don’t offer VCUG alternatives at all, leaving parents in the dark about their existence. In some cases, physicians advocate against alternative measures of care, all of which have been established as safe and reliable. Many providers stress VCUG as the best and only way to diagnose VUR effectively.
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This is false. We can do better, and we must do better. We must equip VCUG conductors with the necessary skills, tools, and training to deliver the highest quality of care to this young and vulnerable patient demographic. Pediatric patients deserve honest, compassionate trauma-informed care, as do the families and parents left to deal with the lasting effects of their child’s VCUG. There is a simple two-step solution: enforcing standardized protocol and legally effective informed consent.
CONTRAST-ENHANCED VOIDING UROSONOGRAPHY (ceVUS)
The VCUG has persisted unchanged and falsely promoted since the 1960s. Moreover, the medical community has been aware that many pediatric patients experience the test as child sexual abuse since 1990. Arguing that VCUG is the sole "gold standard" in pediatric urology is not simply not true, nor should it be true given how long this procedure has been performed.
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Through meticulous research and actively listening to hundreds of VCUG survivors—critical tasks that we strongly encourage healthcare professionals to also make time for—our research team has various theories for the nonsensical continued promotion of VCUG as the only diagnostic test for VUR, including:
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Convenience: The “gold standard” VCUG didn’t get its name by accident. The test has been widely performed for decades. Given its prominence, the majority of physicians are comfortable and confident in performing it. We assume the VCUG is shorter than other procedures and easier for doctors to perform, allowing hospitals to rotate patients in-and-out as quickly as possible to maximize profits.
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Cost: The VCUG costs less than most of its established alternatives, leading medical organizations to offer the VCUG as the sole means of diagnosing VUR in kids. This is demonstrated by the fact that the safer and more effective alternative, ceVUS, saves families an average of $800 compared to the VCUG. In this regard, perhaps the VCUG is indeed the “gold” standard, with the ability to maximize revenue for hospitals.
WHAT DOES RESEARCH SAY ABOUT CEVUS VS. VCUG?
NOVEMBER 2021
Safety assessment and diagnostic evaluation of patients undergoing contrast-enhanced urosonography
"ceVUS combines a diagnostic tool with a high sensitivity and specificity which, according to previous study results, was even shown to be superior to VCUG. Nevertheless, despite the recommendation of the EFSUMB, the ceVUS has not found a widespread use in clinical diagnostics in Europe yet..."
JANUARY 2021
Evaluation of the diagnostic value of contrast-enhanced voiding urosonography (ceVUS)
"In addition to the gold standard of voiding cystourethrography (VCUG), contrast-enhanced urosonography (ceVUS) offers a radiation-free procedure, which, despite its advantages, is not yet widely used. With its high sensitivity and intraoperative validation, ceVUS offers an excellent alternative to VCUG, the gold standard in the diagnosis of VUR. In addition, ceVUS is a radiation-free examination method with a low risk profile that offers an exceptional diagnostic tool in the diagnostic clarification of recurrent urinary tract infections with the suspected diagnosis of VUR and should also be included in the consideration of a diagnosis next to the established VCUG, especially in younger children."
MAY 2021
Contrast-enhanced voiding urosonography in the assessment of vesical-ureteral reflux: The time has come
"During the last 20 years, the diagnostic approach to this entity has passed through several, drastic changes: indeed, since its introduction in 1994 contrast-enhanced voiding urosonography (ceVUS) has gradually accompanied the voiding cystourethrography (VCUG) as alternative imaging technique for the diagnosis and staging of VUR. Despite a large number of papers has strongly encouraged its use in clinical practice, due to the lack of ionizing radiations and its high sensitivity rate, to date almost all the guidelines only include the VCUG for VUR diagnosis. The introduction of technologically advanced US software and the approval of the intravesical administration of ultrasound contrast agents by the FDA and by the EMA have to induce the Scientific Community to a deep revaluation of the role of ceVUS in the diagnosis and follow-up of VUR: urosonography might extensively replace VCUG as the reference method, reserving to cystourethrography a role in the most complex anatomic settings for pre-surgical evaluation."
What does critically appraised research say about VCUG and alternative testing?
Our team has gathered 50+ pages of research about VCUG risks, alternatives, medical necessity, and more. Learn more below.