Low-grade Vesicoureteral Reflux Variability in Grade on Sequential Radiographic and Nuclear Cystograms

Objectives: Postnatal evaluation of vesicoureteral reflux (VUR) remains controversial in patients with antenatal hydronephrosis (HN). The objective of this study was to identify the significance of mild postnatal HN as a marker of VUR and its severity. Materials and Methods: Sonographic findings of 248 children (351 kidneys) with persistent postnatal HN were evaluated for the incidence and severity of primary VUR. Results: The majority of patients had mild (67.8%) HN, followed by moderate (27.6%) and severe (4.6%) HN. VUR was identified in 14.7% of patients with mild HN, 18.5% of patients with moderate HN, and 18.7% of patients with severe HN. About 11.44% of patients with mild HN had low-grade VUR, followed by moderate (45.71 %) and severe grades (42.85%). Conclusion: A large number (89%) of patients with mild HN had moderate to severe VUR. In this cohort, renal sonography was not a reliable method for the prediction of VUR and its severity in patients with mild postnatal HN. However, it was reliable for high grades of VUR. These results are limited due to the study design and the inability to generalize these findings. These results should be replicated across other multiple clinics, thereby recruiting more variety of patients, to validate these study recommendations.

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Antibiotic Prophylaxis for Children with Primary Vesicoureteral Reflux: Where Do We Stand Today?

Advances in Urology ◽

10.1155/2008/217805 ◽

2008 ◽

Vol 2008 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Michiel Costers ◽

Rita Van Damme-Lombaerts ◽

Elena Levtchenko ◽

Guy Bogaert

Keyword(s):

Antibiotic Prophylaxis ◽

Vesicoureteral Reflux ◽

Renal Damage ◽

Low Grade ◽

Urogenital System ◽

Recurrent Utis ◽

School Aged Children ◽

Tract Infections ◽

American Urological Association

The main goal of the management of vesicoureteral reflux (VUR) is prevention of recurrent urinary tract infections (UTIs), and thereby prevention of renal parenchymal damage possibly ensuing from these infections. Long-term antibiotic prophylaxis is common practice in the management of children with VUR, as recommended in 1997 in the guidelines of the American Urological Association. We performed a systematic review to ascertain whether antibiotics can be safely discontinued in children with VUR and whether prophylaxis is effective in the prevention of recurrent UTIs and renal damage in these patients. Several uncontrolled studies indicate that antibiotic prophylaxis can be discontinued in a subset of patients, that is, school-aged children with low-grade VUR, normal voiding patterns, kidneys without hydronephrosis or scars, and normal anatomy of the urogenital system. Furthermore, a few recent randomized controlled trials suggest that antibiotic prophylaxis offers no advantage over intermittent antibiotic therapy of UTIs in terms of prevention of recurrent UTIs or new renal damage.

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Antibiotic Prophylaxis for the Prevention of Recurrent Urinary Tract Infection in Children With Low Grade Vesicoureteral Reflux: Results From a Prospective Randomized Study

The Journal of Urology ◽

10.1016/j.juro.2007.09.090 ◽

2008 ◽

Vol 179 (2) ◽

pp. 674-679 ◽

Cited By ~ 219

Author(s):

G. Roussey-Kesler ◽

V. Gadjos ◽

N. Idres ◽

B. Horen ◽

L. Ichay ◽

...

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Antibiotic Prophylaxis ◽

Vesicoureteral Reflux ◽

Recurrent Urinary Tract Infection ◽

Randomized Study ◽

Prospective Randomized Study ◽

Low Grade

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

Canadian Urological Association Journal ◽

10.5489/cuaj.3610 ◽

2016 ◽

Vol 10 (5-6) ◽

pp. 210 ◽

Cited By ~ 5

Author(s):

Linda C. Lee ◽

Armando J. Lorenzo ◽

Martin A. Koyle

Keyword(s):

Urinary Tract ◽

Vesicoureteral Reflux ◽

Urinary Tract Infections ◽

Renal Scarring ◽

High Rate ◽

Voiding Cystourethrography ◽

Low Grade ◽

Endoscopic Injection ◽

Febrile Uti ◽

Tract Infections

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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