If vesicoureteral reflux is suspected due to dysfunctional voiding and recurrent urinary tract infections, what is the appropriate intervention?

• A. Initiate a bladder retraining program
• B. Order a voiding cystourethrogram
• C. Refer to a urologist for evaluation
• D. Treat with prophylactic antibiotics

Answer: (B)

When vesicoureteral reflux is suspected in a child with dysfunctional voiding and recurrent UTIs, the priority is to confirm whether reflux is present and to grade its severity. The voiding cystourethrogram does this by imaging the bladder and urethra during filling and, crucially, during voiding after catheterization; if reflux occurs, contrast is seen moving up into the ureters, allowing grading from I to V. This diagnostic step directly informs how to manage the condition, from observation with potential antibiotic prophylaxis to surgical correction in higher grades. Treating dysfunctional voiding with bladder retraining helps address symptoms but does not diagnose reflux. Prophylactic antibiotics are a management option after reflux is documented, not the initial diagnostic step. Referring to a urologist is appropriate if results are abnormal or specialized expertise is needed, but the first, most informative test when VUR is suspected is the VCUG.