Commentary to “The prognostic impact of an abnormal initial renal ultrasound on early reflux resolution”

Abstract

This study follows on the heels of a similar recent publication [1]. Sjostrom and colleagues analysed the predictive factors for the resolution of congenital high-grade vesicoureteric reflux (VUR). It was a prospective well-constructed study, and it was concluded that, on multivariate analysis, bladder dysfunction, breakthrough urine infection (UTI) and renal abnormality were all strong negative predictive indicators for the resolution of VUR. This current study had the laudable aim of investigating whether a much simpler predictive indicator of early VUR resolution, the initial renal ultrasound scan (US), could be identified.Thesame institutionhadpreviously reported thatan abnormal renal isotopescanwasanegativepredictive indicator of VUR resolution, and thus had experience and a track record in this area [2]. It was a logical progression to investigate the predictive impact of US, as it is the commonest investigation in children presenting with urinary tract pathology. Despite identifying many limitations to the study it was stated that: ‘Our data can be utilized when counselling patients with grade II and III reflux. In this setting, an abnormal renal ultrasound may have an incrementally lower resolution rate than would be expected by grade alone’. I have considerable concern about this, as I do not believe the data support this statement, and it is possible that such published conclusions could lead to the inappropriate surgical treatment of large numbers of children.