Spontaneous Resolution of Vesicoureteral Reflux: A 15-Year Perspective

Schwab, C. William; Wu, Hsi‐Yang; Selman, Heather; Smith, Grahame H; Snyder, Howard M.; Canning, Douglas A.

doi:10.1016/s0022-5347(05)64225-5

Cited by 154 publications

(46 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A recent study reported that low-grade VUR (grades I to III) diagnosed after UTI resolves significantly more rapidly than does high-grade VUR (grades IV to V) [21]. Camacho et al [8] evaluated the prognostic value of DMSA renal scans performed during febrile UTI and reported that the frequency of VUR was higher by as much as 48% when the DMSA scan result was abnormal than the frequency of VUR when the DMSA scan result was normal in children (12%).…”

Section: Discussionmentioning

confidence: 99%

Abnormal Dimercaptosuccinic Acid Scan May Be Related to Persistence of Vesicoureteral Reflux in Children with Febrile Urinary Tract Infection

Kim

Yoo

et al. 2012

Korean J Urol

View full text Add to dashboard Cite

PurposeThis study assessed whether 99mtechnetium dimercaptosuccinic acid (DMSA) scintigraphy used for the assessment of renal sequelae after febrile urinary tract infection (UTI) has any prognostic value for outcome measurement of vesicoureteral reflux (VUR) by retrospectively evaluating the correlation between abnormal DMSA scintigraphy results and persistence of VUR in children with febrile UTI.Materials and MethodsThe medical records of 142 children (57 boys, 85 girls) admitted with febrile UTI from January 2004 to December 2006 and who were followed up for more than 1 year were retrospectively reviewed. At the initial and follow-up visits, renal ultrasound and DMSA scans were performed within 7 days from the diagnosis and voiding cystourethrography (VCUG) was performed within 1 month in all case and follow-up evaluations.ResultsThe children's mean age was 4.8±3.6 years (range, 0.3 to 14 years). The mean follow-up was 28.2±4.8 months. At the initial examination, VUR was more often associated with an abnormal DMSA scan result (83.3%) than with a normal DMSA scan result (16.7%, p=0.02). The frequency of VUR with an abnormal DMSA scan during acute UTI was significantly higher than the frequency of VUR with a normal DMSA scan (38.8% vs, 25.8%, respectively, p=0.004). Also, high-grade VUR was associated with an abnormal DMSA scan result (32.5%) more often than with a normal DMSA scan result (0%, p=0.01). Children with an abnormal DMSA scan had a lower resolution rate of VUR (17.5%) than did children with a normal DMSA scan (75.0%) at the follow-up VCUG (p=0.02).ConclusionsAn abnormal result on a DMSA scan during febrile UTI is associated with high-grade and persistent VUR. DMSA scans performed during febrile UTI are useful in reflux resolution in childhood.

show abstract

Section: Discussionmentioning

confidence: 99%

Abnormal Dimercaptosuccinic Acid Scan May Be Related to Persistence of Vesicoureteral Reflux in Children with Febrile Urinary Tract Infection

Kim

Yoo

et al. 2012

Korean J Urol

View full text Add to dashboard Cite

show abstract

“…4, 5 However, recently studies have shown UTI, pyelonephritis, and renal scarring rates are not statistically different among VUR patients receiving AP and those not. 6–8 One possible explanation for these findings is patient noncompliance with AP.…”

Section: Introductionmentioning

confidence: 99%

Compliance With Antibiotic Prophylaxis in Children With Vesicoureteral Reflux: Results From a National Pharmacy Claims Database

Copp

Nelson²,

Shortliffe

et al. 2010

Journal of Urology

View full text Add to dashboard Cite

Purpose Antibiotic prophylaxis (AP) is commonly used for medical management of vesicoureteral reflux (VUR). Little information exists on AP compliance in VUR patients. Materials and Methods We queried the Innovus i3 pharmacy claims 2002–2007 database for children ≤18yrs with VUR (ICD-9 code 593.7, plus claim for cystogram) and analyzed those with at least 1yr of follow-up data. Criteria for management with AP were ≥two 30-day supply antibiotic prescriptions or ≥four 14-day supply prescriptions if the antibiotic was a penicillin or cephalosporin. AP compliance was determined using a medication possession ratio, an estimate of the proportion of time that patients have a prescribed drug available for use. Compliance was established as a medication possession ratio of ≥80%, meaning coverage with AP for ≥80% of the year. Results 5,342 out of 9,496 VUR patients (56.3%) were managed on AP. Most patients were female (81%) and ≤5yrs old (79%). Trimethoprims/sulfonamides were most commonly prescribed (62%); antiseptics were next (24%). 40% of patients on AP were compliant. Compliance was lower for 6–10yr olds (OR .71, 95CI 0.61–0.83) and 11–18yr olds (OR 0.56, 95CI 0.41–0.79) compared to younger children (≤5yrs). Increased compliance was associated with ≥1 hospitalizations (OR 1.70, 95CI 1.48–1.97) and ≥1 urologist visits (OR 1.41, 95CI 1.25–1.58). Conclusions 40% of VUR patients on AP are compliant, with young age, frequent hospitalization, and specialist visits associated with compliance. This knowledge may help to develop effective interventions to improve compliance and underscores the importance of reporting compliance in clinical studies evaluating the utility of AP in VUR management.

show abstract

“…The purpose of continuous antibiotic prophylaxis is to keep the urine “sterile” so that the risk of retrograde renal infection will be decreased. Since a significant proportion of reflux cases will spontaneously resolve with time, 4,5 many authors recommend a conservative approach, ie continuous antibiotic prophylaxis, as the initial management option in children, reserving surgical intervention for those in whom continuous antibiotic prophylaxis is ineffective at preventing urinary tract infection.…”

mentioning

confidence: 99%

Efficacy of Antibiotic Prophylaxis in Children with Vesicoureteral Reflux: Systematic Review and Meta-Analysis

et al. 2015

View full text Add to dashboard Cite

Purpose Controversy exists regarding the use of continuous antibiotic prophylaxis vs observation in the management of children with vesicoureteral reflux. The reported effectiveness of continuous antibiotic prophylaxis in children with reflux varies widely. We determined whether the aggregated evidence supports use of continuous antibiotic prophylaxis in children with vesicoureteral reflux. Materials and Methods We searched the Cochrane Controlled Trials Register, clinicaltrials.gov, MEDLINE®, EMBASE®, Google Scholar and recently presented meeting abstracts for reports in any language. Bibliographies of included studies were then hand searched for any missed articles. The study protocol was prospectively registered at PROSPERO (No. CRD42014009639). Reports were assessed and data abstracted in duplicate, with differences resolved by consensus. Risk of bias was assessed using standardized instruments. Results We identified 1,547 studies, of which 8 are included in the metaanalysis. Pooled results demonstrated that continuous antibiotic prophylaxis significantly reduced the risk of recurrent febrile or symptomatic urinary tract infection (pooled OR 0.63, 95% CI 0.42–0.96) but, if urinary tract infection occurred, increased the risk of antibiotic resistant organism (pooled OR 8.75, 95% CI 3.52–21.73). A decrease in new renal scarring was not associated with continuous antibiotic prophylaxis use. Adverse events were similar between the 2 groups. Significant heterogeneity existed between studies (I2 50%, p = 0.03), specifically between those trials with significant risk of bias (eg unclear protocol descriptions and/or lack of blinding). Conclusions Compared to no treatment, continuous antibiotic prophylaxis significantly reduced the risk of febrile and symptomatic urinary tract infections in children with vesicoureteral reflux, although it increased the risk of infection due to antibiotic resistant bacteria. Continuous antibiotic prophylaxis did not significantly impact the occurrence of new renal scarring or reported adverse events.

show abstract

Spontaneous Resolution of Vesicoureteral Reflux: A 15-Year Perspective

Abstract: Grades I to III primary vesicoureteral reflux diagnosed after urinary tract infection resolve at identical rates and significantly more rapidly than grades IV to V. Early repair of grade IV to V reflux should be considered after age 18 months.

Cited by 154 publications

References 17 publications

Abnormal Dimercaptosuccinic Acid Scan May Be Related to Persistence of Vesicoureteral Reflux in Children with Febrile Urinary Tract Infection

Abnormal Dimercaptosuccinic Acid Scan May Be Related to Persistence of Vesicoureteral Reflux in Children with Febrile Urinary Tract Infection

Compliance With Antibiotic Prophylaxis in Children With Vesicoureteral Reflux: Results From a National Pharmacy Claims Database

Efficacy of Antibiotic Prophylaxis in Children with Vesicoureteral Reflux: Systematic Review and Meta-Analysis

Contact Info

Product

Resources

About