MP54-02 MULTI-INSTITUTIONAL ANALYSIS AND VALIDATION OF THE VESICOURETERAL REFLUX INDEX (VURX)

Abstract

You have accessJournal of UrologyPediatrics: Urinary Tract Infections/Vesicoureteral Reflux1 Apr 2015MP54-02 MULTI-INSTITUTIONAL ANALYSIS AND VALIDATION OF THE VESICOURETERAL REFLUX INDEX (VURX) Angela M. Arlen, Aaron D. Weiss, Michael Garcia-Roig, Traci Leong, Christopher S. Cooper, and Andrew J. Kirsch Angela M. ArlenAngela M. Arlen More articles by this author , Aaron D. WeissAaron D. Weiss More articles by this author , Michael Garcia-RoigMichael Garcia-Roig More articles by this author , Traci LeongTraci Leong More articles by this author , Christopher S. CooperChristopher S. Cooper More articles by this author , and Andrew J. KirschAndrew J. Kirsch More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2025AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Diagnosis and management of vesicoureteral reflux (VUR) in young children remains controversial. VURx is a novel tool designed to predict spontaneous reflux resolution in children less than 2 years of age. We performed a multi-institutional validation study, evaluating improvement and resolution rates of young children with newly diagnosed VUR. METHODS Children diagnosed with primary VUR before 24 months of age with ≥2 VCUGs were identified. A 1-6 point VURx was assigned as previously described [Figure 1A]. Demographics, VUR grade and timing, ureteral anomalies, and radiographic outcomes were evaluated. Time to event analysis was performed to identify predictors of time to spontaneous VUR resolution. Resolution was defined as a negative VCUG and improvement as a ≥2 grade decrease in maximum VUR grade. RESULTS Three hundred and sixty-nine children (219 girls, 150 boys) from participating institutions met all inclusion criteria. Mean age at diagnosis was 4.7 ± 4.9 months. One hundred and one patients (27.4%) had early to mid-filling, 214 (58%) late filling and 54 (14.6%) had voiding only VUR. Mean maximum VUR grade was 2.7 ± 1.1; 87 children (23.6%) had high-grade reflux. Ureteral anomalies, complete duplication or periureteral diverticulum (PUD), were observed in 51 children (13.8%). Mean VURx was 3.1 ± 1 with the following breakdown: 1 (17), 2 (88), 3 (151), 4 (78) and 5-6 (35). VURx 1 to 5-6 had improvement/resolution rates of 88.2%, 77.3%, 62.3%, 32.1% and 14.3%, respectively, consistent with the previously published rates (p=0.818) [Figure 1B]. Children with filling phase VUR (p<0.001), grade 4-5 reflux (p<0.001), and ureteral anomalies (p=0.003) had significantly longer median times to improvement or resolution on time to event analysis. Median time to spontaneous resolution was 12.6, 12.7, 15.1, 25.6 and 31 months for VURx 1 to 5-6, respectively. Sixty-five children (17.6%) underwent surgical intervention during the follow-up period. CONCLUSIONS VURx is a simple, validated tool that reliably predicts significant improvement and spontaneous resolution of primary reflux in children diagnosed prior to 2 years of age. In an era where optimal management of VUR remains debatable, the VURx provides additional prognostic information facilitating individualized patient care. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e664 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Angela M. Arlen More articles by this author Aaron D. Weiss More articles by this author Michael Garcia-Roig More articles by this author Traci Leong More articles by this author Christopher S. Cooper More articles by this author Andrew J. Kirsch More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...