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Hari P, Meena J, Kumar M, Sinha A, Thergaonkar RW, Iyengar A, Khandelwal P, Ekambaram S, Pais P, Sharma J, Kanitkar M, Bagga A. Evidence-based clinical practice guideline for management of urinary tract infection and primary vesicoureteric reflux. Pediatr Nephrol 2024; 39:1639-1668. [PMID: 37897526 DOI: 10.1007/s00467-023-06173-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/27/2023] [Accepted: 09/17/2023] [Indexed: 10/30/2023]
Abstract
We present updated, evidence-based clinical practice guidelines from the Indian Society of Pediatric Nephrology (ISPN) for the management of urinary tract infection (UTI) and primary vesicoureteric reflux (VUR) in children. These guidelines conform to international standards; Institute of Medicine and AGREE checklists were used to ensure transparency, rigor, and thoroughness in the guideline development. In view of the robust methodology, these guidelines are applicable globally for the management of UTI and VUR. Seventeen recommendations and 18 clinical practice points have been formulated. Some of the key recommendations and practice points are as follows. Urine culture with > 104 colony forming units/mL is considered significant for the diagnosis of UTI in an infant if the clinical suspicion is strong. Urine leukocyte esterase and nitrite can be used as an alternative screening test to urine microscopy in a child with suspected UTI. Acute pyelonephritis can be treated with oral antibiotics in a non-toxic infant for 7-10 days. An acute-phase DMSA scan is not recommended in the evaluation of UTI. Micturating cystourethrography (MCU) is indicated in children with recurrent UTI, abnormal kidney ultrasound, and in patients below 2 years of age with non-E. coli UTI. Dimercaptosuccinic acid scan (DMSA scan) is indicated only in children with recurrent UTI and high-grade (3-5) VUR. Antibiotic prophylaxis is not indicated in children with a normal urinary tract after UTI. Prophylaxis is recommended to prevent UTI in children with bladder bowel dysfunction (BBD) and those with high-grade VUR. In children with VUR, prophylaxis should be stopped if the child is toilet trained, free of BBD, and has not had a UTI in the last 1 year. Surgical intervention in high-grade VUR can be considered for parental preference over antibiotic prophylaxis or in children developing recurrent breakthrough febrile UTIs on antibiotic prophylaxis.
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Affiliation(s)
- Pankaj Hari
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Jitendra Meena
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Manish Kumar
- Department of Pediatrics, Chacha Nehru Bal Chikitsalya, New Delhi, India
| | - Aditi Sinha
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | | | - Arpana Iyengar
- Department of Pediatric Nephrology, St. Johns Medical College and Hospital, Bengaluru, India
| | - Priyanka Khandelwal
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sudha Ekambaram
- Department of Pediatric Nephrology, Apollo Children's Hospital, Chennai, India
| | - Priya Pais
- Department of Pediatric Nephrology, St. Johns Medical College and Hospital, Bengaluru, India
| | - Jyoti Sharma
- Department of Pediatrics, KEM Hospital, Pune, India
| | | | - Arvind Bagga
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
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Contini G, Mele E, Barneschi AC, Esposito C, Castagnetti M. Voiding cystourethrography in patients undergoing endoscopic decompression of duplex system ureteroceles: to do or not to do? Pediatr Surg Int 2024; 40:103. [PMID: 38598017 PMCID: PMC11006722 DOI: 10.1007/s00383-024-05665-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE To assess the role of voiding cystourethrography (VCUG) in patients with duplex system ureterocele (DSU) undergoing endoscopic decompression (ED). MATERIALS AND METHODS This is a retrospective study of 75 consecutive patients with DSU undergoing ED [median (range) age, 6 (1-148) months]. Patients were divided into 3 groups, 33 with a VCUG showing vesicoureteral reflux (VUR) before ED (VUR-group), 22 with a VCUG negative for VUR (No-VUR-group), and 20 who did not undergo a VCUG (No-VCUG-group). Secondary surgery (SS) rate was compared among groups. RESULTS Groups were comparable for baseline characteristics. SS rate was 82% (27/33) in VUR-group vs. 32% (7/22) in the No-VUR-group (p = 0.0001), and 25% (5/20) in the No-VCUG-group (p = 0.001 vs. VUR-group, and 1 vs. No-VUR-group). In the VUR-group, 9 patients underwent preemptive endoscopic treatment of VUR during ED and SS rate was 44% (4/9) vs. 96% (23/24) in the remainder, p= 0.003. In the No-VCUG-group, a VCUG was performed during follow-up in 9/15 patients and showed reflux in all, although only 2 of these developed a (single) urinary tract infections. CONCLUSIONS SS rate was significantly higher in patients with preoperative VUR. Instead, it was not significantly different between patients without VUR and those who did not undergo a VCUG before ED, despite all the latter who underwent a VCUG during follow-up had evidence of VUR generally in the absence of symptoms. In our opinion, a VCUG could be limited to patients developing symptoms after ED. If a VCUG is performed before ED, a preemptive treatment of VUR should be taken into consideration.
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Affiliation(s)
- Giorgia Contini
- Division of Pediatric Urology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy
| | - Ermelinda Mele
- Division of Pediatric Urology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy
| | - Andrea Celeste Barneschi
- Division of Pediatric Urology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy
| | - Ciro Esposito
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy
| | - Marco Castagnetti
- Division of Pediatric Urology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy.
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padua, Italy.
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Singhal N, Gopal M, Ali A, McGlade F, Ahmed I, Harkensee C, Gittins N, Senasi R, Peace R, Athiraman N, Tse Y. The prevalence of familial vesicoureteric reflux in infants with normal antenatal scans. Acta Paediatr 2022; 111:1808-1813. [PMID: 35642352 DOI: 10.1111/apa.16434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 11/26/2022]
Abstract
AIM To determine the prevalence of familial vesicoureteric reflux (VUR) by studying the outcomes of screening in a contemporary cohort of newborns with normal antenatal kidney scans. METHODS A review of screening outcomes in newborns with a first degree relative with VUR, normal antenatal scans and no prior urine infections between 2014-2019 at three maternity units in the North East of England was conducted. Imaging consisted of micturating cystourethrogram (MCUG) in all and renal tract ultrasound scan (RUS) routinely in two units and by clinician preference in one unit. RESULTS At a median age of 59 days, 265 infants underwent MCUG. High-grade VUR (Grades 3-5) was detected in 13 (4.9%) and low-grade VUR (Grades 1-2) in 24 (9.1%). In the 152 infants who had a RUS, abnormalities were detected in 21 (13.8%). An abnormal postnatal RUS has a low positive predictive value (14.3%) for high-grade VUR, but a normal RUS has a high negative predictive value (95.4%). CONCLUSION Compared to historical cohorts from two decades ago, the yield from familial VUR screening is low and unjustifiable in the setting of normal antenatal anomaly scans.
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Affiliation(s)
- Nidhi Singhal
- Department of Paediatric Nephrology Great North Children’s Hospital Newcastle Upon Tyne UK
| | - Milan Gopal
- Department of Paediatric Urology Great North Children’s Hospital Newcastle Upon Tyne UK
| | - Alaa Ali
- Department of Paediatric Nephrology Great North Children’s Hospital Newcastle Upon Tyne UK
| | - Fiona McGlade
- Department of Neonatology Sunderland Royal Hospital Sunderland UK
| | - Imran Ahmed
- Department of Neonatology Sunderland Royal Hospital Sunderland UK
| | | | - Nicola Gittins
- Department of Paediatrics Queen Elizabeth Hospital Gateshead UK
| | - Ramdas Senasi
- Department of Radiology Sunderland Royal Hospital Sunderland UK
| | - Richard Peace
- Department of Nuclear Medicine Royal Victoria Infirmary Newcastle Upon Tyne UK
| | - Naveen Athiraman
- Department of Neonatology Royal Victoria Infirmary Newcastle Upon Tyne UK
| | - Yincent Tse
- Department of Paediatric Nephrology Great North Children’s Hospital Newcastle Upon Tyne UK
- Faculty of Medical Sciences Newcastle University Newcastle Upon Tyne UK
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Bar-Sever Z, Shammas A, Gheisari F, Vali R. Pediatric Nephro-Urology: Overview and Updates in Diuretic Renal Scans and Renal Cortical Scintigraphy. Semin Nucl Med 2022; 52:419-431. [PMID: 35031115 DOI: 10.1053/j.semnuclmed.2021.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 11/11/2022]
Abstract
Nuclear medicine offers several diagnostic scans for the evaluation of congenital and acquired conditions of the kidneys and urinary track in children. Tc-99m-MAG 3 diuretic renal scans are most commonly used in the evaluation and follow up of urinary track dilatations. They provide functional information on the differential renal function and on drainage quality which is allows distinction between obstructed and non-obstructed kidneys and the need for surgical correction vs conservative management in kidneys with impaired drainage. Standardized imaging and processing protocols are essential for correct interpretation and for meaningful comparisons between follow up scans. Different approaches and conceptions led to some contradicting recommendations between SNMMI and EANM guidelines on diuretic renography in children which caused confusion and to the emergence of self-made institutional protocols. In Late 2018 the two societies published joint procedural guidelines on diuretic renography in infants and children which hopefully will end the confusion. Tc-99m DMSA scans provide important information about the function of the renal cortex allowing detection of acute pyelonephritis, renal scars dysplasia and ectopy as well as accurate determination of the differential renal function. They are commonly used in the evaluation of children with urinary tract infections and affect clinical management. A standardized imaging and processing protocol improves the diagnostic accuracy of these studies. SPECT or pinhole images should be a routine part of the imaging protocol. This is one of the recommendations in the new EANM and SNMMI procedural guidelines for renal cortical scintigraphy in children available online on the SNMMI website and is under publication. This article provides an overview on the clinical role of diuretic renography and cortical scintigraphy in children and describes the imaging protocols focusing on the new recommendations in the procedural guidelines.
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Affiliation(s)
- Zvi Bar-Sever
- Department of Nuclear Medicine, Schneider Children's Medical Center, Petach Tikva, Tel-Aviv University, Israel.
| | - Amer Shammas
- Department of Nuclear Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario Canada
| | - Farshid Gheisari
- Department of Nuclear Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario Canada
| | - Reza Vali
- Department of Nuclear Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario Canada
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Sakakura H, Shono K, Hashimoto Y, Shono T. Infantile urethrovaginal reflux in three cases. Pediatr Int 2022; 64:e14736. [PMID: 34657355 DOI: 10.1111/ped.14736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/04/2021] [Accepted: 04/09/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Hikari Sakakura
- Department of Pediatric Surgery and Pediatric Urology, NHO Kokura Medical Center, Kitakyushu, Japan.,Primary Trainee, NHO Kokura Medical Center, Kitakyushu, Japan
| | - Kumiko Shono
- Department of Pediatric Surgery and Pediatric Urology, NHO Kokura Medical Center, Kitakyushu, Japan
| | - Yoshiko Hashimoto
- Department of Pediatric Surgery and Pediatric Urology, NHO Kokura Medical Center, Kitakyushu, Japan
| | - Takeshi Shono
- Department of Pediatric Surgery and Pediatric Urology, NHO Kokura Medical Center, Kitakyushu, Japan
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Tokat E, Gurocak S, Ozkan S, Dogan HS, Citamak B, Satar N, Izol V, Deger M, Sarikaya S, Bostanci Y, Gulsen M, Onal B, Altinay Kirli E, Burgu B, Soygur T, Haciyev P, Agras K, Karabulut B, Akbal C, Akin Sekerci C, Demirci D, Baydilli N, Tekgul S, Ozgur Tan M. Clinical practice in vesicoureteral reflux with respect to EAU guidelines: A multicenter study. Int J Clin Pract 2021; 75:e14339. [PMID: 33966353 DOI: 10.1111/ijcp.14339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/04/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE We designed a multicenter, retrospective study to investigate the current trends in initial management of reflux with respect to European Association of Urology (EAU) Guidelines in Urology clinics of our country. MATERIALS AND METHODS The study group consisted of 1988 renal units (RU) of 1345 patients treated surgically due to vesicoureteral reflux (VUR) (between years 2003 and 2017) in nine different institutions. Patients were divided into two groups according to time of initial treatment and also grouped according to risk factors by "EAU guidelines on VUR." RESULTS In this series, 1426 RUs were treated initially conservatively and 562 RUs were initially treated with surgery. In initially surgically treated group, success rates of surgery decreased significantly in low and moderate risk groups after 2013 (P = .046, P = .0001, respectively), while success rates were not significantly different in high risk group (P = .46). While 26.6% of patients in low risk group were initially surgically treated before 2013, this rate has increased to 34.6% after 2013, but the difference was not statistically significant (P = .096). However, performing surgery as the initial treatment approach increased significantly in both moderate and high risk groups (P = .000 and P = .0001, respectively) after 2013. Overall success rates of endoscopic treatments and ureteroneocystostomy (UNC) operations were 65% and 92.9% before 2013 and 60% and 78.5% after 2013, respectively. Thus, the overall success rate for surgery was 72.6%. There was significant difference between success rates of UNC operations before and after 2013 (P = .000), while the difference was not significant in the injection group (P = .076). CONCLUSION Current trends in management of reflux in our country do not yet follow the EAU guidelines on VUR in low and moderate risk groups despite these reliable and accepted guidelines were expected to influence our daily approach.
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Affiliation(s)
- Eda Tokat
- Department of Urology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Serhat Gurocak
- Department of Pediatric Urology, Gazi University School of Medicine, Ankara, Turkey
| | - Secil Ozkan
- Department of Public Health, Gazi University School of Medicine, Ankara, Turkey
| | - Hasan Serkan Dogan
- Department of Pediatric Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Burak Citamak
- Department of Pediatric Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Nihat Satar
- Department of Urology, Cukurova University School of Medicine, Adana, Turkey
| | - Volkan Izol
- Department of Urology, Cukurova University School of Medicine, Adana, Turkey
| | - Mutlu Deger
- Department of Urology, Cukurova University School of Medicine, Adana, Turkey
| | - Saban Sarikaya
- Department of Urology, Samsun Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Yakup Bostanci
- Department of Urology, Samsun Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Murat Gulsen
- Department of Urology, Samsun Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Bulent Onal
- Department of Pediatric Urology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Elif Altinay Kirli
- Department of Pediatric Urology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Berk Burgu
- Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Tarkan Soygur
- Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Perviz Haciyev
- Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Koray Agras
- Department of Pediatric Urology, Gazi University School of Medicine, Ankara, Turkey
| | - Bilge Karabulut
- Department of Pediatric Urology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Trainig and Research Hospital, Ankara, Turkey
| | - Cem Akbal
- Department of Urology, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Cagri Akin Sekerci
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Deniz Demirci
- Department of Urology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Numan Baydilli
- Department of Urology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Serdar Tekgul
- Department of Pediatric Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mustafa Ozgur Tan
- Department of Pediatric Urology, Gazi University School of Medicine, Ankara, Turkey
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Akbalık Kara M, Taktak A, Alparslan C. Retrospective evaluation of the pediatric multicystic dysplastic kidney patients: experience of two centers from southeastern Turkey. Turk J Med Sci 2021; 51:1331-1337. [PMID: 33512816 PMCID: PMC8283448 DOI: 10.3906/sag-2011-175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/28/2021] [Indexed: 11/05/2022] Open
Abstract
Background/aim The objective of this study is to determine the clinical features of unilateral multicystic dysplastic kidney (MCDK) patients. Materials and methods The demographic, clinical, laboratory, and radiologic features of MCDK patients at Diyarbakır Children’s Hospital and Diyarbakır Gazi Yaşargil Training and Research Hospital between January 2008-June 2019 were retrospectively evaluated. Results A total of 111 [59 (53.2%) male and 52(46.8%) female] patients with MCDK were followed for a mean period of 41.89 ± 32.03 months. MCDK was located on the left and right sides in 46 (41.4%) and 65 (58.6%) of the children, respectively (p > 0.05). A total of 87 (78.4%) patients had antenatal diagnosis. The mean age at diagnosis was 13.7 ± 34.2 months. Of the 49 voiding cystourethrogram (VCUG)-performed patients, vesicoureteral reflux was detected in 11 patients (22.4%). Other associated urological anomalies in the patients were detected in 12 (10.8%) patients. On Tc-99m dimercaptosuccinic acid (DMSA) scintigraphy which was performed in all patients showed scarring in four children. Eight patients had history of UTI (7.2%). Renal failure, hypertension, and proteinuria were diagnosed in three children (2.7%). Sixty-nine (62%) patients developed compensatory hypertrophy. Conclusion All cases should be followed up closely and VCUG should be reserved for patients with recurrent UTI and other urological problems indicated by ultrasonography and abnormal DMSA scan results.
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Affiliation(s)
- Mehtap Akbalık Kara
- Department of Pediatric Nephrology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Aysel Taktak
- Department of Pediatric Nephrology, Faculty of Medicine, Mustafa Kemal University, Antakya, Turkey
| | - Caner Alparslan
- Department of Pediatric Nephrology, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
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8
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Kidney damage associated with vesico ureteric reflux. Curr Opin Pediatr 2021; 33:247-251. [PMID: 33534423 DOI: 10.1097/mop.0000000000000996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to highlight the most recent developments in the understanding of kidney damage associated with vesico ureteral reflux. The severe damage, with major adverse long-term sequelae, was thought to be, for the most part, the result of pyelonephritis, predisposed to by vesico ureteral reflux. RECENT FINDINGS It is now recognized that there are two distinct forms of kidney damage (congenital and acquired), in association with reflux. We examined the most recent research regarding these two conditions. SUMMARY The most recent articles focus on an understanding and the possible interventions for the congenital and acquired abnormalities of the kidney, associated with reflux. Of particular interest in congenital disorders, is the importance of urothelium and gene mutations in normal and aberrant development of the urinary tract. As regards the predisposition to urinary tract infections and kidney scarring, the importance of uromodulin in the defence mechanism preventing infection, and the role of interventions aimed at reducing scarring, such as vitamin A and steroids during the acute phase of the infection, are discussed. A recent article of particular value demonstrated the absence of long-term adverse outcomes during pregnancy, in women investigated for urinary tract infections in childhood.
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Roesch J, Harms M, Berger C, Oswald J, Haid B. Targeted Indication of Imaging for Detection of Vesicoureteric Reflux after Pediatric Febrile Urinary Tract Infections Based on a Multiparametric Computational Tool. Indian J Pediatr 2020; 87:1001-1008. [PMID: 32495217 DOI: 10.1007/s12098-020-03329-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 04/29/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Diagnostic workup after febrile urinary tract infections (fUTIs) in children remains a matter of debate. The authors aimed to evaluate multiple parameters in order to design a predictive tool enabling a targeted indication of voiding cystourethrography (VCUG). METHODS Records of 383 consecutive children who underwent a VCUG as well as a dimercaptosuccinic-acid (DMSA) scan after febrile urinary tract infections (fUTIs) at a single institution between 04/2009 and 06/2014 were reviewed. Twenty parameters were recorded. After regression analysis, 6 parameters were incorporated into a computational tool aiming at a targeted indication of an eventual VCUG. The performance of the tool was prospectively tested on 100 patients. RESULTS Postpyelonephritic alterations on DMSA, duplex systems, age 1-3 y, duration of fever >3 d, >2 fUTIs before VCUG and abnormal sonography findings were identified as significant predictors (p < 0.05 each); the presence of bladder and bowel dysfunction (BBD) was negatively associated with vesicoureteric reflux (VUR). The resulting computational tool achieved an Area under the curve (AUC) of 0.686 (CI 0.633-0.740). Prospective evaluation (100 new patients) revealed a sensitivity of 85.1%, a specificity of 49.1%, a positive predictive value of 59.7% and a negative predictive value of 78.7%. CONCLUSIONS The differentiated indication of a VCUG based on the use of a tool was efficient in optimizing the specificity of the diagnostic algorithm after fUTIs. The tool outperformed other common clinical approaches in terms of VUR detection and VCUG frequency. After validation and further refinement in a multicentric approach, this strategy could significantly enhance VUR detection whilst reducing the number of VCUGs.
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Affiliation(s)
- Judith Roesch
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Seilerstätte 4, 4020, Linz, Austria
| | - Mirjam Harms
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Seilerstätte 4, 4020, Linz, Austria
| | - Christoph Berger
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Seilerstätte 4, 4020, Linz, Austria
| | - Josef Oswald
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Seilerstätte 4, 4020, Linz, Austria
| | - Bernhard Haid
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Seilerstätte 4, 4020, Linz, Austria.
- Department of Urology, Ludwig Maximilians University (LMU), Munich, Germany.
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Bastos JM, Rondon AV, Machado MG, Zerati M, Nascimento RLP, Lima SVC, Calado ADA, Barroso U. Brazilian consensus on vesicoureteral reflux-recommendations for clinical practice. Int Braz J Urol 2020; 46:523-537. [PMID: 32167732 PMCID: PMC7239285 DOI: 10.1590/s1677-5538.ibju.2019.0401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/01/2019] [Indexed: 12/11/2022] Open
Abstract
Introduction Vesicoureteral Reflux (VUR) is characterized by a retrograde flow of urine from the bladder into the ureters and kidneys. It is one of the most common urinary tract anomalies and the major cause of urinary tract infection (UTI) in the first years of life. If not properly diagnosed and treated can lead to recurrent UTI, renal scar and, in severe cases, to end stage renal disease. Despite recent advances in scientific and technological knowledge, evaluation and treatment of VUR is still controversial and there is still considerable heterogeneity in evaluation methods and therapeutic approaches. The aim of the present consensus is to give a practical orientation on how to evaluate and treat VUR. Methods The board of Pediatric Urology of the Brazilian Society of Urology joined a group of experts and reviewed all important issues on Vesicoureteral Reflux evaluation and treatment and elaborated a draft of the document. On November 2017 the panel met to review, discuss and write a consensus document. Results and Discussion Vesicoureteral Reflux is a common and challenging problem in children. Children presenting with Vesicoureteral Reflux require careful evaluation and treatment to avoid future urinary tract infections and kidney scars. The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies.
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Affiliation(s)
- José Murillo Bastos
- Universidade Federal de Juiz de Fora -UFJF, Juiz de Fora, MG, Brasil.,Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e Saúde de Juiz de Fora - HMTJ-SUPREMA, Juiz de Fora, MG, Brasil
| | - Atila Victal Rondon
- Universidade do Estado do Rio de Janeiro - UERJ, Rio de Janeiro, RJ, Brasil.,Hospital Federal Cardoso Fontes - HFCF, Rio de Janeiro, RJ, Brasil
| | | | - Miguel Zerati
- Instituto de Urologia e Nefrologia de São José do Rio Preto - IUN, S J do Rio Preto, SP, Brasil
| | | | | | - Adriano de Almeida Calado
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo - HCFMRP-USP, Ribeirão Preto, SP, Brasil
| | - Ubirajara Barroso
- Universidade Federal da Bahia - UFBA, Salvador, BA, Brasil.,Escola Bahiana de Medicina - BAHIANA, Salvador, BA, Brasil
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Voiding Cystourethrogram in Children With Unilateral Multicystic Dysplastic Kidney: Is It Still necessary? Urology 2020; 139:156-160. [PMID: 32081673 DOI: 10.1016/j.urology.2020.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/25/2020] [Accepted: 02/04/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the value of the voiding cystourethrogram (VCUG) in children with multicystic dysplastic kidney (MCDK) who have a normal versus abnormal contralateral kidney and bladder ultrasound (US), and assess the risk of having vesicoureteral reflux (VUR) or urinary tract infection (UTI) based on the US results. METHODS A retrospective chart review including children with unilateral MCDK with postnatal US and VCUG available at our institution between January 2008 and September 2017 was performed. Analysis was done to find association between abnormal contralateral US and contralateral VUR and UTI. RESULTS One hundred and fifty-six children were analyzed; 118(75.6%) patients had a normal contralateral kidney US, while 38(24.4%) had abnormal US. The rate of severe contralateral VUR (grade IV and V) was 2 (1.7%) and 5 (13.2%) in children with normal and abnormal contralateral US, respectively. The risk analysis demonstrated a significant association between severe VUR on the contralateral kidney and an abnormal contralateral US (odds ratio = 7.73; 95%CI: 1.43-41.81; P = 0.018) and no significant association with UTI (odds ratio = 1.58; 95%CI: 0.50-4.94; P = 0.435). CONCLUSION Our data suggests, the rate of severe contralateral VUR in children with unilateral MCDK and normal contralateral kidney is low. VCUG should be considered for infants with proven MCKD and alterations on the contralateral kidney on US. Following patients with MCDK and normal contralateral kidney without the use of VCUG is a reasonable approach, unless there is development of signs and symptoms of recurrent UTI or deterioration of the renal function. We found that abnormal contralateral kidney US was associated with severe VUR.
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