Is the first urinary infection in childhood a definite indication for radiological examination?

The need for X-ray investigations of the urinary tract at the time of the first proven urinary infection, even in older girls, is stressed. This policy is the best way to detect chronic pyelonephritis and congenital anomalies of the urinary tract and provide timely and appropriate treatment. These conclusions are supported by personal experience (see case description), and the incidence of congenital anomalies encountered during an 11 year period in our children's hospital. There were 957 concecutive cases with X-ray studies of the urinary tract (IVP and MCU). A considerable proportion (30%) were older children (4-12 years) having supravesical obstruction defined when the X-ray studies were performed at the first urinary infection. The proportion of abnormalities rose to 66% when the investigations were done after recurrent infections, which may contribute to the development and progression of disease.