Treatment of occult reflux lowers the incidence rate of pediatric febrile urinary tract infection.
Publication/Presentation Date
7-1-2008
Abstract
OBJECTIVES: To examine whether vesicourethral reflux diagnosed by positioned instillation of contrast (PIC-VUR) shows clinical importance by comparing the incidence rates of febrile urinary tract infection (FUTI) before and after treatment of PIC-VUR.
METHODS: Beginning in 2001 we used a multi-institutional registry to prospectively enroll consecutive pediatric patients with a history of FUTI without VUR according to voiding cystourethrogram (VCUG) and yet who show PIC-VUR. Treatment of PIC-VUR was with prophylactic antimicrobials or antireflux surgery. The post-treatment occurrence of FUTI was tracked.
RESULTS: A total of 14 centers enrolled 118 patients (mean age, 7.2 years; range, 0.5 to 20 years). Parents self-selected the treatment of PIC-VUR as endoscopic injection (104), ureteral reimplantation (3), or antimicrobial prophylaxis (11). Study intervals surveying for FUTI before PIC (mean, 12 months; range, 1 to 17 years) and after PIC treatment (mean, 11 months; range, 0 to 3 years) were not significantly different. Overall the incidence rate for FUTI decreased significantly from 0.16 per patient per month before PIC-VUR treatment to 0.008 per patient per month after treatment (rate ratio 20; 95% confidence interval 11 to 36). The post-treatment rate of FUTI in patients treated with antibiotics versus surgery was not significantly different (rate ratio 2.5; 95% confidence interval 0.33 to 27).
CONCLUSIONS: The diagnosis of PIC-VUR is clinically important because children treated for PIC-VUR with either antimicrobial prophylaxis or surgery show a significant reduction in the incidence rate of FUTI. This is the basis for a current prospective study randomizing patients with PIC-VUR to treatment or observation.
Volume
72
Issue
1
First Page
72
Last Page
76
ISSN
1527-9995
Published In/Presented At
Hagerty, J., Maizels, M., Kirsch, A., Liu, D., Afshar, K., Bukowski, T., Caione, P., Homsy, Y., Meyer, T., Kaplan, W., & PIC Cystography Group (2008). Treatment of occult reflux lowers the incidence rate of pediatric febrile urinary tract infection. Urology, 72(1), 72–76. https://doi.org/10.1016/j.urology.2008.02.004
Disciplines
Medicine and Health Sciences
PubMedID
18407331
Department(s)
Department of Surgery
Document Type
Article