MP44-01 A COMPARISON OF PRACTICE PATTERNS IN THE MANAGEMENT OF VESICOURETERAL REFLUX BETWEEN PEDIATRIC UROLOGISTS AND PEDIATRIC NEPHROLOGISTS

Abstract

INTRODUCTION AND OBJECTIVES: Vesicoureteral reflux (VUR) is often diagnosed and managed by both Pediatric Urologists (PU) and Pediatric Nephrologists (PN), yet little data exists comparing practice patterns between these two subspecialties. We sought to describe practice variation between PU and PN as it pertains to VUR. METHODS: An e-mail invitation was sent to 675 SPU and 753 ASPN members. Survey Monkey was used to obtain demographic and practice pattern data for commonly encountered clinical scenarios relating to VUR and urinary tract infection (UTI). Data from non-PU/PN responders and from those answering fewer than 37 of the 39 questions (95%) was excluded from analysis. Statistical analysis was performed using SPSS 17.0. Categorical variables were compared using Chisquare test or Fisher’s Exact Test. Pair-wise comparisons were made using the Bonferroni adjustment. RESULTS: 255 (18%) physicians responded; of these, 4 (2%) were non-PU/PN and 48 (19%) answered 95% of survey questions, resulting in a final cohort of 203 respondents (133 PU, 70 PN). Age and practice setting were similar; more non-US PU than PN responded to the survey (20% vs. 7%, P<0.05). 98% of PU and 83% of PN responded that they would evaluate a child with a single febrile UTI with imaging (p<0.001). 91% of PU and 99% of PN would evaluate a child with a multiple afebrile UTIs with imaging (p<0.001). Independent of the type of UTI, PU favor using KUB and DMSA more frequently than PN, whereas PN prefer renal sonogram or VCUG. 78% and 74% of PU were somewhat/very likely to consider deflux or reimplant for breakthrough infection, versus 60% and 28% of PN (p<0.05). 91% of PU vs. 76% of PN believe that treating bowel and bladder dysfunction (BBD) alone may lead to resolution of VUR (p<0.01). BBD screening by PU (58%) involved history and other modalities; PN rely most often on history alone (60%). 58% of urologists are somewhat/very likely to screen siblings with sonogram versus 40% of nephrologists (p<0.01). PU and PN were equally concerned with the emergence of resistant bacterial organisms when making decisions regarding prophylactic antibiotics (PN 72% vs. PU 69%). CONCLUSIONS: Minimal consensus exists between PU and PN in the diagnosis and management of VUR. PU use more diverse imaging in diagnosis and are more likely to pursue surgical intervention for breakthrough UTIs than PN. More aggressive evaluation for BBD by PU than PN may be related to belief in the impact BBD on VUR resolution. Further investigation is necessary to determine if practice variation is related to training, society guidelines, or other factors.