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VCUG for 4 year Old Boy Whose Baby Brother Has Hydronephrosis

Some background first:  my 10 month old baby boy has bilateral hydronephrosis (grade 3 on right side, grade 2 on left side) and dodged/delayed surgery by showing some improvement at his last renal scan.  Urologist says he needs to continue to show improvement in next month's ultrasound or he'll again recommend surgery.  By the time he was 2 weeks old he tested negative for reflux and posterior urethral valves.  We're accustomed to worrying about and getting testing for our baby.

Last weekend our 4 year old son was diagnosed with a UTI (urinary tract infection).  He had severe pain during urination, frequent urination, and many accidents.  No fever.  He hasn't had pain for 3 days now, but is still having accidents.  Yesterday our pediatrician recommended an ultrasound and VCUG for our 4 year old.  

Question 1:  is a VCUG necessary for our 4 year old?  When our baby was diagnosed, we asked if our older son should be tested and the answer was always no.  The urgent care doctor who saw him for the UTI didn't think there was any family link between the baby's hydronephrosis and the 4 year old's UTI.  Again, the baby tested negative for reflux - and I surely hope once he tests negative he should always be negative.

Question 2:  Assuming a VCUG is necessary, what type of sedation can we use?  I've read about versed and a strong version of laughing gas.  Our 4 year old has high anxiety when it comes to doctors.  For example, at last week's dentist appointment (at a pediatric dentist office), they wouldn't clean his teeth because he screamed so loudly and was so agitated.  We were moved to another room because he was upsetting the other children.  We had to hold him down for the dental exam and fluoride treatment and that was traumatic for him and us.  This was his 3rd time to the dentist and the first two times were not that bad; for some reason, he seems to be getting worse.

The ultrasound will be stressful enough for him but he'll just have to handle it.  At least that's not painful.

I'm worried about the VCUG.  What can we do make the VCUG bearable for him?  As much as I worry about sedation for a child, I feel it is essential for him given his personality.  Can they give him versed (to ease the stress from the IV and catheter) and then sedate him during the test?  Any suggestions?  

Thank you.
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