Vesico‐ureteric reflux: occurrence and long‐term risks

Jacobson, Stefan H.; Hansson, Sverker; Jakobsson, B

doi:10.1111/j.1651-2227.1999.tb01315.x

Cited by 143 publications

(42 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…20 The link between renal scarring and ESRD is based on registry data ( Table 54). 21 We assumed that the mean age of ESRD onset following infection-related scarring was 13.67 years, 152 with a range of 7 to 24 years, 153 based on the results of two observational studies. We also assumed that half of children with ESRD would be treated with dialysis, with the remainder treated with renal transplant.…”

Section: Long-term Probabilitiesmentioning

confidence: 99%

The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness

Hay

Birnie²,

Busby³

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

BackgroundIt is not clear which young children presenting acutely unwell to primary care should be investigated for urinary tract infection (UTI) and whether or not dipstick testing should be used to inform antibiotic treatment.ObjectivesTo develop algorithms to accurately identify pre-school children in whom urine should be obtained; assess whether or not dipstick urinalysis provides additional diagnostic information; and model algorithm cost-effectiveness.DesignMulticentre, prospective diagnostic cohort study.Setting and participantsChildren < 5 years old presenting to primary care with an acute illness and/or new urinary symptoms.MethodsOne hundred and seven clinical characteristics (index tests) were recorded from the child’s past medical history, symptoms, physical examination signs and urine dipstick test. Prior to dipstick results clinician opinion of UTI likelihood (‘clinical diagnosis’) and urine sampling and treatment intentions (‘clinical judgement’) were recorded. All index tests were measured blind to the reference standard, defined as a pure or predominant uropathogen cultured at ≥ 105colony-forming units (CFU)/ml in a single research laboratory. Urine was collected by clean catch (preferred) or nappy pad. Index tests were sequentially evaluated in two groups, stratified by urine collection method: parent-reported symptoms with clinician-reported signs, and urine dipstick results. Diagnostic accuracy was quantified using area under receiver operating characteristic curve (AUROC) with 95% confidence interval (CI) and bootstrap-validated AUROC, and compared with the ‘clinician diagnosis’ AUROC. Decision-analytic models were used to identify optimal urine sampling strategy compared with ‘clinical judgement’.ResultsA total of 7163 children were recruited, of whom 50% were female and 49% were < 2 years old. Culture results were available for 5017 (70%); 2740 children provided clean-catch samples, 94% of whom were ≥ 2 years old, with 2.2% meeting the UTI definition. Among these, ‘clinical diagnosis’ correctly identified 46.6% of positive cultures, with 94.7% specificity and an AUROC of 0.77 (95% CI 0.71 to 0.83). Four symptoms, three signs and three dipstick results were independently associated with UTI with an AUROC (95% CI; bootstrap-validated AUROC) of 0.89 (0.85 to 0.95; validated 0.88) for symptoms and signs, increasing to 0.93 (0.90 to 0.97; validated 0.90) with dipstick results. Nappy pad samples were provided from the other 2277 children, of whom 82% were < 2 years old and 1.3% met the UTI definition. ‘Clinical diagnosis’ correctly identified 13.3% positive cultures, with 98.5% specificity and an AUROC of 0.63 (95% CI 0.53 to 0.72). Four symptoms and two dipstick results were independently associated with UTI, with an AUROC of 0.81 (0.72 to 0.90; validated 0.78) for symptoms, increasing to 0.87 (0.80 to 0.94; validated 0.82) with the dipstick findings. A high specificity threshold for the clean-catch model was more accurate and less costly than, and as effective as, clinical judgement. The additional diagnostic utility of dipstick testing was offset by its costs. The cost-effectiveness of the nappy pad model was not clear-cut.ConclusionsClinicians should prioritise the use of clean-catch sampling as symptoms and signs can cost-effectively improve the identification of UTI in young children where clean catch is possible. Dipstick testing can improve targeting of antibiotic treatment, but at a higher cost than waiting for a laboratory result. Future research is needed to distinguish pathogens from contaminants, assess the impact of the clean-catch algorithm on patient outcomes, and the cost-effectiveness of presumptive versus dipstick versus laboratory-guided antibiotic treatment.FundingThe National Institute for Health Research Health Technology Assessment programme.

show abstract

Section: Long-term Probabilitiesmentioning

confidence: 99%

The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness

Hay

Birnie²,

Busby³

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

show abstract

“…According to the previous studies approximately 2% of patients experience UTI in their first year of life and approximately 30-40% of them has associated VUR [5,6]. In the diagnosis of VUR the most important modality is voiding cystoureterogram however,, this is an invasive method with high radiation dose.…”

Section: Discussionmentioning

confidence: 99%

Ureter Visualization on Tc-99m DMSA Scintigraphy in Pediatric Patients

Kara¹,

Zp²,

Mk³

2017

J Kidney

View full text Add to dashboard Cite

Purpose: The aim of this study is to investigate possible reasons of ureter visualization on Tc-99m DMSA scintigraphy. Methods:The planar static renal scintigraphies of pediatric patients (n=2290) who attended for any reason between January 2009 and May 2015 were analyzed retrospectively by the same nuclear medicine physician. In our analysis 15 patients (12 Male (M), 3 Female (F); 0-12, mean: 4 ± 3, 8 years old) were included in the study due to bilateral or unilateral ureter visualization on Tc-99m DMSA scintigraphy. Results:In the visual assessment of scintigraphies, there were 7 patients with bilateral visualization and 8 patients (right in 4 patients, left in 4 patients) with unilateral. Additionally increased background activity was observed in two patients. Cortical defects and/or atrophy of kidneys were observed in 10 (66%) of the patients. The background pathology in these patients were posterior urethral valve (n=3), neurogenic bladder due to meningomyelocele (n=4), vesicoureteral reflux (n=3), urethral atresia (n=2), ureterovesical obstruction (n=1) and unknown (n=2). Conclusion:Ureter visualization on Tc-99m DMSA imaging usually accompanies severe kidney damage and ureteral or bladder pathology. Additionally this finding may point out the patients who could not be corrected completely by the surgical way but this issue has to be evaluated by future studies.

show abstract

“…Vesicoureteral reflux (VUR) represents the retrograde flow of urine from the bladder to the upper urinary tract, and the most common and important padiatric anomaly of the urinary tract (1,2). In most children, reflux is a birth defect and is caused by an abnormal attachment between the ureter and bladder, the ureterovesical junction (UVJ), with a short, ineffective flap valve.…”

Section: Introductionmentioning

confidence: 99%

Efficiency of endoscopic treatment compared to open surgical management of the vesicoureteral reflux

Mugabe¹,

Kojović²

2018

Medicinski podmladak

View full text Add to dashboard Cite

Introduction: Vesicoureteral reflux (VUR) represents the retrograde flow of urine from the bladder to the upper urinary tract. It can be managed by continuous antibiotic prophylaxis of the urinary tract infections until spontaneous resolution occurs, surgical ureteral reimplantation (ureteroneocystostomy), or endoscopic treatment by injecting bulking agents. The aim: To assess the efficacy of the endoscopic treatment of VUR in comparison to the ureteroneocystostomy. Material and methods: The first group included 300 children with VUR, II to IV grades managed by endoscopic injection from 2005 to 2015, and second group included 300 patients who underwent surgical treatment for the IV or V grade of VUR from 1997 until 2009. The results of treatment and complication rate were analysed and compared. We did the same analysis considering the total number of ureteral units. Results: Of total of 300 patients treated endoscopically, in 281 (93.67%) patients the reflux was completely resolved; in 10 (3.33%), the reflux was downgraded (decreased for one or two grades) and in 9 (3%) the intervention was unsuccessful. In 430 ureteral units, full resolution was achieved in 402 (93.49%) units; in 10 (2.33%), the reflux was downgraded and in 18 (4.65%) the reflux didn't resolve. In 300 patients who underwent open surgery, in 290 (96.7%) the reflux was resolved; in 8 (2.67%), the reflux was downgraded from the V/IV to the grades I to III; in 2 (0.66%) the operation was unsuccessful. Out of 480 ureteral units, in 463 (96.46%) units the reflux was resolved; in 13 (2.71%), the grade of reflux was reduced, while in 4 (0.83%) units the reflux was persistent. Recorded success rate didn't show any statistically significant difference between these two groups. The length of hospital stay was significantly shorter and the number of complications was lower in the group of patients treated by endoscopic injection. Conclusion: Comparable success rate, shorter hospital stay, and fewer complications make the endoscopic treatment more preferable option.

show abstract

Vesico‐ureteric reflux: occurrence and long‐term risks

Cited by 143 publications

References 53 publications

The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness

The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness

Ureter Visualization on Tc-99m DMSA Scintigraphy in Pediatric Patients

Efficiency of endoscopic treatment compared to open surgical management of the vesicoureteral reflux

Contact Info

Product

Resources

About