Pediatric Vesicoureteral Reflux Guidelines Panel Summary Report on the Management of Primary Vesicoureteral Reflux in Children

Elder, Jack S.; Peters, Craig A.; Arant, Billy S.; Ewalt, David H.; Hawtrey, Charles E.; Hurwitz, Roger A.; Parrott, Thomas S.; Snyder, Howard M.; Weiß, Robert; Woolf, Steven H.; Hasselblad, Vic

doi:10.1097/00005392-199705000-00093

Cited by 117 publications

(202 citation statements)

References 4 publications

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“…Two of the authors, both pediatric surgeons with more than 8 years of experience in the management of VUR, both provided with the same clinical notes including clinical history and standard US and DMSA scans, advised independently children's management each blindly to one imaging modality. Therapeutic options were in agreement with presently most accepted guidelines for the management of primary VUR [1] and were summarized as follows: (1) start chemoprophylaxis (newly detected VUR), (2) stop or do not start chemoprophylaxis (negative investigation in a child free from UTIs), (3) keep on chemoprophylaxis (persisting VUR), (4) formal ureteral reimplantation (breakthrough UTIs or worsening in DMSA scan and/or in US appearance of the kidneys).…”

Section: Methodssupporting

confidence: 60%

“…Hence, outcome is largely independent from surgery [14] and a nonoperative treatment has become the first-line approach to VUR, no matter what grade or laterality [1,[12][13][14][15]. Surgery seems indicated only on a clinical ground, potential indications for reimplantation being breakthrough UTIs, appearance of new renal scars or worsening in renal function during follow-up, and parents' noncompliance with long-term prophylaxis [1,12]. Accordingly, accuracy of the imaging modality in grading VUR seems no longer paramount.…”

Section: Discussionmentioning

confidence: 99%

“…Primary vesicoureteric reflux (VUR) seldom requires surgery, but may often involve periodical assessments during conservative follow-up [1]. Such controls are classically accomplished by voiding cystourethrographies (VCUGs).…”

mentioning

confidence: 99%

“…Such controls are classically accomplished by voiding cystourethrographies (VCUGs). However, owing to the potential adverse effects related to the use of ionizing radiation, the development of alternative imaging modalities has been claimed in recent years [1].…”

mentioning

confidence: 99%

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Discrepancy between power-Doppler voiding urosonography and voiding cystourethrography is not relevant for the management of primary vesicoureteric reflux

Castagnetti

Cimador

Tudisco

et al. 2006

Journal of Pediatric Surgery

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Section: Methodssupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Discrepancy between power-Doppler voiding urosonography and voiding cystourethrography is not relevant for the management of primary vesicoureteric reflux

Castagnetti

Cimador

Tudisco

et al. 2006

Journal of Pediatric Surgery

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“…This change derives from the understanding that we should be avoiding renal damage rather more than diagnosing reflux, since both surgery and antibiotic prophylaxis are progressively being abandoned for most cases of vesicoureteral reflux (VUR) [2,3]. The most significant event which will bring a child to active management is recurrence of UTI [4,5]. It seems therefore more clinically relevant to differentiate between children who will suffer recurrent episodes of UTI and those who will not, rather than to simply identify which children have VUR.…”

mentioning

confidence: 99%

Children with abnormal DMSA nuclear scan present a higher risk of recurrent febrile urinary tract infections

et al. 2018

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The ideal management of a child presenting a first episode of febrile urinary tract infection is still under debate. In the recent guidelines for the diagnosis and management of urinary tract infections (UTI) in children, the American Association of Pediatrics recommend performing a post-UTI sonography, and if there are abnormal findings, a voiding cystourethrogram [1]. This change derives from the understanding that we should be avoiding renal damage rather more than diagnosing reflux, since both surgery and antibiotic prophylaxis are progressively being abandoned for most cases of vesicoureteral reflux (VUR) [2,3]. The most significant event which will bring a child to active management is recurrence of UTI [4,5]. It seems therefore more clinically relevant to differentiate between children who will suffer recurrent episodes of UTI and those who will not, rather than to simply identify which children have VUR. We therefore aimed to evaluate if DMSA nuclear scan could reliably identify which children were at risk of presenting a second febrile UTI.We retrospectively analyzed all children aged between 2 and 24 months, without prenatally diagnosed uropathy, who were admitted to our institution for a first febrile UTI between 2009 and 2013, had a post-urinary tract infection sonography and DMSA nuclear scan, and were followed for at least 24 months. We excluded patients with missing or incomplete data, or lost to follow-up. Febrile UTI was defined as fever > 38 °C associated with positive urinalysis and urine culture (> 10 5 CFU/mL urine) collected through catheterization in girls, and clean-catch in boys. We noted patient's characteristics, and the results of the DMSA scan performed within 1 month of the acute episode. DMSA scans were categorized as normal, i.e., no scarring or dysplasia, or abnormal, any degree of scarring or dysplasia, functional impairment or atrophy.After the first febrile UTI, parents were systematically counseled about early diagnosis and having a urinalysis done if their child presented unexplained fever. None were given antibiotic prophylaxis but they were given advice about local hygiene and measures to avoid constipation in their child. All children were followed at least once every 6 months for a minimum of 24 months. The main outcome was recurrence of a second febrile UTI within the first 24 months of follow-up. In case of recurrence, a cystogram was performed, and children were further managed accordingly.On hundred and seven children were included in our study. There were 49 boys and 58 girls (45.8/54.2%). None were lost to follow-up, and all relevant data were available for all included patients. Children included did not differ from those who were excluded from the study. The mean age at first febrile UTI was 6.8 ± 5.4 months. Twenty-four (22.4%) children presented abnormal DMSA findings. Six presented asymmetric function without signs of dysplasia or scarring, two had a solitary kidney, and 16 had signs of dysplasia or scarring, of which 6 had asymmetric function. Sixteen (14.9%)...

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Antibiotic Resistance Patterns in Children Hospitalized for Urinary Tract Infections

Lutter

Currie²,

Mitz³

et al. 2005

Arch Pediatr Adolesc Med

143

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Pediatric Vesicoureteral Reflux Guidelines Panel Summary Report on the Management of Primary Vesicoureteral Reflux in Children

Abstract: For most children the panel recommended continuous antibiotic prophylaxis as initial treatment. Surgery was recommended for children with persistent reflux and other indications, as specified in the document.

Cited by 117 publications

References 4 publications

Discrepancy between power-Doppler voiding urosonography and voiding cystourethrography is not relevant for the management of primary vesicoureteric reflux

Discrepancy between power-Doppler voiding urosonography and voiding cystourethrography is not relevant for the management of primary vesicoureteric reflux

Children with abnormal DMSA nuclear scan present a higher risk of recurrent febrile urinary tract infections

Antibiotic Resistance Patterns in Children Hospitalized for Urinary Tract Infections

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