Vesicoureteral Reflux Index: 2-Institution Analysis and Validation

Arlen, Angela M.; Garcia-Roig, Michael; Weiss, Aaron D.; Leong, Traci; Cooper, Christopher S.; Kirsch, Andrew J.

doi:10.1016/j.juro.2015.03.094

Cited by 22 publications

(28 citation statements)

References 34 publications

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“…Patients with a lower VURx have a greater probability of spontaneous resolution. Therefore, the VURx reliably predicts primary VUR improvement/resolution in children . The distal UDR is calculated as the widest diameter of the distal ureter in the false pelvis divided by the distance between L1 and L3 …”

Section: Are There Any Alternatives To Vcug?mentioning

confidence: 99%

“…Therefore, the VURx reliably predicts primary VUR improvement/resolution in children. [163][164][165] The distal UDR is calculated as the widest diameter of the distal ureter in the false pelvis divided by the distance between L1 and L3. 166 UDR measurement on the VCUG is objective, whereas the International Reflux Grading System is subjective.…”

Section: Prediction Of Vur Resolutionmentioning

confidence: 99%

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Pediatric voiding cystourethrography: An essential examination for urologists but a terrible experience for children

et al. 2018

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Voiding cystourethrography is the most important fluoroscopic examination in pediatric urology for the investigation of lower urogenital tract diseases, such as vesicoureteral reflux or urethral stricture. However, this invasive procedure imposes a significant burden on children and their parents, and recently there has been a paradigm shift in the diagnosis and treatment of vesicoureteral reflux. In the 2011 revision, the American Academy of Pediatrics guidelines on urinary tract infection recommended abandoning routine voiding cystourethrography after the first febrile urinary tract infection. In 2014, the randomized intervention for children with vesicoureteral reflux study recommended discontinuation of routine continuous antibiotic prophylaxis for vesicoureteral reflux. The time is now ripe to radically reconsider indications for voiding cystourethrography and the procedure itself.

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Section: Are There Any Alternatives To Vcug?mentioning

confidence: 99%

Section: Prediction Of Vur Resolutionmentioning

confidence: 99%

Pediatric voiding cystourethrography: An essential examination for urologists but a terrible experience for children

et al. 2018

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“…Longitudinal studies have shown that ~50–65 % of cases of non-syndromic primary VUR undergo spontaneous resolution with age [26–29]. Not much is known about the mechanism leading to this resolution, however the elongation of the intravesical ureter (0.5 cm at birth vs. 1.5–2.5 cm in adulthood) due to somatic growth has been offered as an explanation for the improved function of the UVJ [30–32].…”

Section: Natural History Of Vurmentioning

confidence: 99%

Vesicoureteral reflux and the extracellular matrix connection

et al. 2016

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Primary vesicoureteral reflux (VUR) is a common pediatric condition due to a developmental defect in the ureterovesical junction. The prevalence of VUR among individuals with connective tissue disorders, as well as the importance of the ureter and bladder wall musculature for the anti-reflux mechanism, suggest that defects in the extracellular matrix (ECM) within the ureterovesical junction may result in VUR. This review will discuss the function of the smooth muscle and its supporting ECM microenvironment with respect to VUR, and explore the association of VUR with mutations in ECM-related genes.

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“…10,38 The VUR index is a simple tool to predict the chance of spontaneous resolution in children under two years of age and assigns a score depending on the gender, bladder volume at onset of VUR, ureteral anatomy, and initial VUR grade. 39 In addition, other concomitant diagnoses may need to be considered and ruled out (e.g., posterior urethral valves, neurogenic bladder, etc. ).…”

Section: What Is the Probability Of Vur?mentioning

confidence: 99%

The role of voiding cystourethrography in the investigation of children with urinary tract infections

Lee

Lorenzo

Koyle

2016

CUAJ

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Urinary tract infections (UTIs) represent a common bacterial cause of febrile illness in children. Of children presenting with a febrile UTI, 25-40% are found to have vesicoureteral reflux (VUR). Historically, the concern regarding VUR was that it could lead to recurrent pyelonephritis, renal scarring, hypertension, and chronic kidney disease. As a result, many children underwent invasive surgical procedures to correct VUR. We now know that many cases of VUR are low-grade and have a high rate of spontaneous resolution. The roles of surveillance, antibiotic prophylaxis, endoscopic injection, and ureteral reimplantation surgery also continue to evolve. In turn, these factors have influenced the investigation of febrile UTIs.Voiding cystourethrography (VCUG) is the radiographic test of choice to diagnose VUR. Due to its invasive nature and questionable benefit in many cases, the American Academy of Pediatrics (AAP) no longer recommends VCUG routinely after an initial febrile UTI. Nevertheless, these guidelines pre-date the landmark Randomized Intervention of Children with Vesicoureteral Reflux (RIVUR) trial and there continues to be controversy regarding the diagnosis and management of VUR. This paper discusses the current literature regarding radiographic testing in children with febrile UTIs and presents a practical risk-based approach for deciding when to obtain a VCUG.

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Vesicoureteral Reflux Index: 2-Institution Analysis and Validation

Abstract: The vesicoureteral reflux index is a simple tool that reliably predicts significant improvement and spontaneous resolution of primary reflux in patients diagnosed at younger than 2 years. The index provides valuable prognostic information, facilitating individualized patient care.

Cited by 22 publications

References 34 publications

Pediatric voiding cystourethrography: An essential examination for urologists but a terrible experience for children

Pediatric voiding cystourethrography: An essential examination for urologists but a terrible experience for children

Vesicoureteral reflux and the extracellular matrix connection

The role of voiding cystourethrography in the investigation of children with urinary tract infections

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