MP70-15 PRIMARY VESICOURETERAL REFLUX IN A MODERN COHORT: WHAT ARE THE RISK FACTORS FOR URINARY TRACT INFECTIONS?

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP70-15 PRIMARY VESICOURETERAL REFLUX IN A MODERN COHORT: WHAT ARE THE RISK FACTORS FOR URINARY TRACT INFECTIONS? Daniel Wilkinson, Matthew Buell, Kai Wen Cheng, Cayde Ritchie, Levi Miles, Jocelyn Huang, Ala’a Farkouh, David Chamberlin, and Joshua Chamberlin Daniel WilkinsonDaniel Wilkinson More articles by this author , Matthew BuellMatthew Buell More articles by this author , Kai Wen ChengKai Wen Cheng More articles by this author , Cayde RitchieCayde Ritchie More articles by this author , Levi MilesLevi Miles More articles by this author , Jocelyn HuangJocelyn Huang More articles by this author , Ala’a FarkouhAla’a Farkouh More articles by this author , David ChamberlinDavid Chamberlin More articles by this author , and Joshua ChamberlinJoshua Chamberlin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003338.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Children with vesicoureteral reflux (VUR) are known to be at increased risk of urinary tract infection (UTI). With a trend towards observational management of children with VUR, untreated VUR and subsequent UTI can lead to significant morbidity. The purpose of this study was to identify risk factors for development of UTI in a modern cohort of children with primary VUR. METHODS: We performed a review of a prospectively maintained clinical database of children with primary VUR at a single children’s hospital from July 2013 to June 2022. Children were included if they were diagnosed with primary VUR by voiding cystourethrography between the ages of 1 day to 18 years. Patients with secondary VUR were excluded. Demographic and clinical data were collected. The primary endpoint was development of a UTI defined by pyuria (>6 WBC/hpf or positive leukocyte esterase) on urinalysis and single-organism urine culture greater than 50,000 CFU/mL. Low-grade (LG) VUR was defined as International VUR grades 1-3 and high-grade (HG) VUR was defined as International VUR grades 4 and 5. Dilated ureter was defined as any ureteral dilation greater than 2 mm. Data were analyzed by performing univariate and multivariate Cox proportional hazards regressions as well as Chi Square tests. RESULTS: A total of 242 children had primary VUR, 116 (47.9%) male and 126 (52.1%) female. UTI occurred in 42 (17.3%) children with primary VUR, with an average follow-up time of 20.1 months [IQR of 6.2 - 45.0]. Female sex (HR: 2.39, 95% CI 1.22 - 4.67, p=0.011) and younger age at presentation of VUR (HR-1: 1.01, 95% CI 1.00 - 1.02, p=0.015) were found to be independent risk factors on multivariate analysis. Univariate analysis showed increased UTI rates in dilated ureter (14.6% non-dilated vs 30.5% dilated, p=0.024), HG VUR grade (13.2% in LG vs 23.7% in HG, p=0.038), and renal pelvis anterior-posterior diameter (APD) (16.9% ≤ 15 mm, 31.9% >15 mm p=0.032). Circumcision, degree of phimosis, constipation, voiding dysfunction, SFU grade of hydronephrosis, and prior febrile UTI were not found to be independent risk factors. CONCLUSIONS: Risk factors for UTI in children with primary VUR include female sex, age younger than 50 days old, dilated ureter, HG VUR, and hydronephrosis with APD greater than 15 mm. Treatment may be individualized to treat these higher risk patients. Further multi-institutional study of patients with primary VUR may help to further elucidate risk factors for UTI and improve the management of these patients. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1009 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Wilkinson More articles by this author Matthew Buell More articles by this author Kai Wen Cheng More articles by this author Cayde Ritchie More articles by this author Levi Miles More articles by this author Jocelyn Huang More articles by this author Ala’a Farkouh More articles by this author David Chamberlin More articles by this author Joshua Chamberlin More articles by this author Expand All Advertisement PDF downloadLoading ...