Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics, etc. – for differential diagnostic workup
- Renal ultrasonography (ultrasound examination of the kidneys) including the draining urinary tract – if pyelonephritis (inflammation of the renal pelvis) is suspected to exclude complicating factors.
- Rectal prostate ultrasonography – when prostatitis (prostatitis) is suspected.
- Uroflowmetry (urine flow measurement) – in chronic cystitis the detection or exclusion of urinary bladder emptying disorders.
- Cystometry (bladder pressure measurement) – in chronic cystitis the detection or exclusion of urinary bladder emptying disorders.
- Micturition cystourethrography (MZU; examination method in which the urinary bladder and urethra before and during micturition with the help of contrast medium in the context of an X-ray examination are represented) or sonographically as micturition ultrasonography (MUS) – to exclude or detect a vesicoureteral reflux (VUR; unphysiological reflux of urine from the bladder via the ureters (ureters) into the renal pelvis).
- Magnetic resonance (MR) urography – when complex malformations of the kidney are suspected; also used to assess renal function, drainage ratios, and scarring of the renal parenchyma, if necessary.
- Endourological examination procedures such as urethrocystoscopy (urethral and bladder endoscopy), ureterorenoscopy (ureter and kidney endoscopy) – only indicated in chronic or chronic recurrent inflammation.
-
DMSA scintigraphy; static radioisotope nephrography using the radionuclide 99mTc-DMSA (2,3-dimercaptosuccinic acid); the examination is used to visualize functioning renal tissue; indications:
- When a febrile urinary tract infection (UTI) occurs in a child to exclude parenchymal scars that may occur in the setting of pyelonephritis (no earlier than 2 months after the occurrence of a febrile UTI); if evidence of parenchymal damage → MZU (see above) to exclude vesicoureteral reflux (VUR) [“top-down” strategy].
- Positive evidence of reflux (vesicoureteral reflux, VUR) [“bottom-up” strategy].
Furthermore, DMSA scintigraphy can also visualize renal abnormalities such as a double or horseshoe kidney.
Cystitis in childhood
The aim of medical device diagnosis of urinary tract infection (UTI) in childhood:
- To detect anatomic abnormalities that promote the infection:
- Outflow obstructions in the urinary tract (e.g., at the pyeloureteral junction or in the terminal ureter).
- Vesicoureteral reflux (VUR; nonphysiologic reflux of urine from the bladder via the ureters (ureters) into the renal pelvis)
- Congenital reflux nephropathy; already before birth, a dilation (expansion) of the upper urinary tract is noticeable (boys more often than girls)
- Distinguish an upper from a lower UTI.
- Detect late sequelae of the infection (scarring of the renal parenchyma)
