MP61-11 A REEVALUATION OF THE RIVUR TRIAL WITH A VALIDATED RISK STRATIFICATION MODEL

Abstract

You have accessJournal of UrologyPediatrics: Urinary Tract Infection and Vesicoureteral Reflux1 Apr 2017MP61-11 A REEVALUATION OF THE RIVUR TRIAL WITH A VALIDATED RISK STRATIFICATION MODEL Zhan Tao (Peter) Wang, Yasaman Alam, Irene McAleer, Ahmed Ali, Josh Chamberlin, Guy Hidas, and Antoine Khoury Zhan Tao (Peter) WangZhan Tao (Peter) Wang More articles by this author , Yasaman AlamYasaman Alam More articles by this author , Irene McAleerIrene McAleer More articles by this author , Ahmed AliAhmed Ali More articles by this author , Josh ChamberlinJosh Chamberlin More articles by this author , Guy HidasGuy Hidas More articles by this author , and Antoine KhouryAntoine Khoury More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1869AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trial showed a 50% reduction in the risk for recurrent urinary tract infection (UTI) in children who received prophylaxis compared to placebo. This conclusion is heavily debated. We reevaluated the RIVUR data using a validated risk stratification model. METHODS Data from all 607 children were used. We stratified the children into low, intermediate and high risk categories based on gender, circumcision status, VUR grade and bladder bowel dysfunction. Febrile or symptomatic UTI recurrence in our stratified placebo and prophylaxis groups were compared using Fisher's exact test. Kaplan-Meier curves and a log-rank test was used for time-to-event analysis. RESULTS There were 389 (65%), 132 (22%) and 50 (8%) children stratified into low, intermediate and high risk categories. The rate of recurrent UTI was not significantly different in low risk children receiving either placebo or prophylaxis (Table 1). Whereas intermediate risk children receiving prophylaxis had a 20% absolute reduction in recurrence compared to placebo. Similarly, there were half as many recurrent UTIs in high risk children on prophylaxis; however this was not significant due to the small sample size. Time-to-event analysis showed no difference in recurrence between the stratified categories with placebo or prophylaxis (p=0.045). CONCLUSIONS The majority (65%) of the children in the RIVUR trial fell into the low risk category and do not benefit from prophylaxis, while intermediate risk children receiving prophylaxis showed a 20% absolute reduction in recurrence. These results favor an individualized approach for the optimal management of children with vesicoureteral reflux. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e803 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Zhan Tao (Peter) Wang More articles by this author Yasaman Alam More articles by this author Irene McAleer More articles by this author Ahmed Ali More articles by this author Josh Chamberlin More articles by this author Guy Hidas More articles by this author Antoine Khoury More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...