646 DOES ROUTINE RENAL ULTRASOUND CHANGE MANAGEMENT IN THE FOLLOW UP OF PATIENTS WITH VESICOURETERAL REFLUX?

Abstract

You have accessJournal of UrologyPediatrics: Urinary Tract Infection/Vesicoureteral Reflux1 Apr 2013646 DOES ROUTINE RENAL ULTRASOUND CHANGE MANAGEMENT IN THE FOLLOW UP OF PATIENTS WITH VESICOURETERAL REFLUX? Jan Rudzinski, Bryce Weber, Armando Lorenzo, Darius Bagli, Walid Farhat, Elizabeth Harvey, and Joao Luiz Pippi Salle Jan RudzinskiJan Rudzinski Calgary, Canada More articles by this author , Bryce WeberBryce Weber Calgary, Canada More articles by this author , Armando LorenzoArmando Lorenzo Toronto, Canada More articles by this author , Darius BagliDarius Bagli Toronto, Canada More articles by this author , Walid FarhatWalid Farhat Toronto, Canada More articles by this author , Elizabeth HarveyElizabeth Harvey Toronto, Canada More articles by this author , and Joao Luiz Pippi SalleJoao Luiz Pippi Salle Toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.199AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Renal ultrasound (RUS) is commonly obtained during follow up evaluation and management of children with vesicoureteral reflux (VUR). Little data exists regarding the role of follow up RUS in children VUR. We sought to evaluate the impact of follow up RUS on the change in clinical management of patients with VUR. METHODS A prospective analysis of consecutive children with a previous diagnosis of VUR, seen in the outpatient clinic with a routine follow up RUS within the past 4 months (Nov 2010-Feb 2011). Variables collected included: demographic data (age, gender and length of follow up), VUR history (VUR grade, laterality, previous surgery, previous renal scars, number of previous urinary tract infections (UTI), and UTI since the last visit), dysfunctional voiding symptoms, along with concurrent RUS findings (renal growth, change in hydronephrosis or new renal scarring) were recorded. Change in management at the time of the visit was defined as the prescription of new medication, restarting antibiotic therapy, nurse counselling for voiding dysfunction, surgery, or further investigations (i.e. DMSA). On RUS, change was considered to be a change in grade of hydronephrosis or presence of new renal scarring. RESULTS The study included 114 consecutive patients. The mean age was 4.5 yrs old, mean age of VUR diagnosis was 1.7 years, with the average child followed for a mean of 2.8 years. A change in management with stable ultrasound findings occurred in 14 patients, in which the change included ordering a DMSA in 9 (64%), nurse counselling for dysfunctional voiding in 3 (21%), and booking surgery in 2 patients (14%). Overall a change on RUS was seen in 4 patients (3 with worsening hydronephrosis and one with suspected new scars). When all the collected variables where analyzed for influence on change in follow up management, only a history of UTI since the last follow up visit was found to be significant (P<0.001). CONCLUSIONS The RUS findings in the great majority of patients followed for VUR remain stable or with minimal changes. The only major variable showing a significant effect on change in management in this prospective analysis was a history of UTI since last follow up visit. In our study, clinical decisions were based on recent history rather than RUS findings. In an era of restricted resources coupled with the limitations of RUS, the value of follow up RUS for children with VUR may need to be further revisited. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e264 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jan Rudzinski Calgary, Canada More articles by this author Bryce Weber Calgary, Canada More articles by this author Armando Lorenzo Toronto, Canada More articles by this author Darius Bagli Toronto, Canada More articles by this author Walid Farhat Toronto, Canada More articles by this author Elizabeth Harvey Toronto, Canada More articles by this author Joao Luiz Pippi Salle Toronto, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...