648 EVOLUTION OF DILATING VESICOURETERAL REFLUX DURING INFANCY USING A CONSERVATIVE MANAGEMENT PROTOCOL (2013)

You have accessJournal of UrologyPediatrics: Urinary Tract Infection/Vesicoureteral Reflux1 Apr 2013648 EVOLUTION OF DILATING VESICOURETERAL REFLUX DURING INFANCY USING A CONSERVATIVE MANAGEMENT PROTOCOL Aaron Martin, Muhammad Iqbal, Bruce Sprague, H. Gil Rushton, Craig Peters, and Hans Pohl Aaron MartinAaron Martin Washington, DC More articles by this author , Muhammad IqbalMuhammad Iqbal Washington, DC More articles by this author , Bruce SpragueBruce Sprague Washington, DC More articles by this author , H. Gil RushtonH. Gil Rushton Washington, DC More articles by this author , Craig PetersCraig Peters Washington, DC More articles by this author , and Hans PohlHans Pohl Washington, DC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.201AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Dilating vesicoureteral reflux (VUR) heightens concern by physicians and parents that an infant is at risk for recurrent urinary tract infection and renal injury. Consequently, corrective surgery is offered while children are quite young if VUR doesn't improve promptly. Current published resolution rates likely do not reflect the true natural history of VUR but rather a bias towards surgical intervention. We analyzed a cohort of infants with dilating VUR managed initially by a conservative non-operative protocol to determine factors related to improvement and resolution of VUR. METHODS The medical records of 90 infants (≤6 months) from 2004 to 2010 presenting for antenatal hydronephrosis or initial febrile urinary tract infection and found to have dilating VUR (grade≥3) were reviewed. All patients were placed on continuous antibiotic prophylaxis of the treating physician's choice and had an initial DMSA scan. Patients with VUR associated with secondary causes or those with non-dilating VUR (grades <3) were excluded. Variables of interest included initial presentation, initial DMSA results, gender/circumcision status, presence of breakthrough UTIs, initial grade of VUR, and presence of bilateral VUR. Regression analysis was performed to determine predictors of spontaneous resolution and/or improvement (grade<3) as well as predictors of surgical intervention. RESULTS A total of 80 infants (113 refluxing renal units) had complete follow-up studies and were included in the final analysis. A combined 50 patients (63%) had resolution (26/80) or improvement to grade <3 (24/80) with a mean follow-up of 29 months prior to resolution and/or discharge. Only 19 patients (24%) underwent surgery (mean age 29 months, range 1-76). Multivariate analysis revealed initial DMSA scan status, occurrence of breakthrough UTIs, circumcision status, and initial VUR grade to be predictors of VUR resolution/improvement (p<0.05). Initial presentation and presence of bilateral VUR were not predictive. DMSA scan abnormalities, clinical presentation, circumcision status, and breakthrough febrile UTIs were all significant predictors of surgery (p<0.05). CONCLUSIONS Dilating VUR in infancy has significant rates of spontaneous resolution/improvement. Therefore, surgery should be recommended based on objective predictors of non-resolution or renal injury after a reasonable period of observation. Further studies are needed to continue to improve risk stratification and more appropriately balance the concerns of over or under-treatment. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e265 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Metrics Author Information Aaron Martin Washington, DC More articles by this author Muhammad Iqbal Washington, DC More articles by this author Bruce Sprague Washington, DC More articles by this author H. Gil Rushton Washington, DC More articles by this author Craig Peters Washington, DC More articles by this author Hans Pohl Washington, DC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...