Incidence Of Vesicoureteral Reflux Research Articles

The postoperative renal function of persistent cloaca patients treated by posterior sagittal anorecto-urethro-vaginopalsty: results of a nationwide survey in Japan.

We investigated the postoperative renal function in persistent cloaca (PC) patients who underwent posterior sagittal anorecto-urethro-vaginopalsty (PSARUVP) and factors influencing the renal functional outcomes. A questionnaire survey was distributed to 244 university and children's hospitals across Japan. Of the 169 patients underwent PSARUVP, 103 patients were enrolled in the present study. Exclusion criteria was patients without data of renal prognosis. The present study showed that renal anomalies (p = 0.09), vesicoureteral reflux (VUR) (p = 0.01), and hydrocolpos (p = 0.07) were potential factors influencing a decline in the renal function. Approximately half of the patients had a normal kidney function, but 45.6% had a reduced renal function (Stage ≥ 2 chronic kidney disease: CKD). The incidence of VUR was significantly higher in the renal function decline (RFD) group than those in the preservation (RFP) group (p = 0.01). Vesicostomy was significantly more frequent in the RFD group than in the RFP group (p = 0.04). Urinary tract infections (p < 0.01) and bladder dysfunction (p = 0.04) were significantly more common in patients with VUR than in patients without VUR. There was no association between the VUR status and the bowel function. Prompt assessment and treatment of VUR along with bladder management may minimize the decline in the renal function.

Accuracy of contrast-enhanced voiding urosonography using Optison™ for diagnosis of vesicoureteral reflux in children

There is limited quality of evidence regarding the accuracy of contrast-enhanced voiding urosonography (ceVUS) for diagnosis of vesicoureteral reflux (VUR) compared to fluoroscopic voiding cystourethrography (VCUG), and minimal data on the use of the ultrasound contrast agent Optison™ for this purpose. To compare the accuracy of ceVUS using Optison™ to VCUG, and to assess inter-rater agreement regarding presence and grading of VUR. In this retrospective investigation, all sequential ceVUS with Optison™ and VCUG studies performed in children between 2014 and 2017 were reviewed. Two raters independently graded all ceVUS studies using a 5-point scale. CeVUS sensitivity and specificity were estimated separately for each rater using the VCUG report as the ground truth for presence and degree of VUR. Logistic and ordinary linear regression models assessed rater-report agreement and inter-rater agreement for each kidney, Optison™ dose, and referral diagnosis. 97 children (51 females) with 101 paired studies were included. Sensitivity and specificity of ceVUS for VUR detection were identical for both raters: right kidney 75%/90.9%; left kidney 85.7%/78.9% (Figure). There was no statistically significant difference in disagreement between raters and the VCUG report for the right or left kidney. Inter-rater agreement on ceVUS grading was 90% and 88% for right and left kidneys, respectively. There was a significant negative association between fetal hydronephrosis vs urinary tract infection and disagreement between Rater 2 and the VCUG report for the left kidney. There were no other significant associations with respect to either kidney, Optison™ dose, or referral diagnosis. Our study showed that detection of VUR with ceVUS and Optison™ is comparable to fluoroscopic VCUG. Based on the VCUG reports, the incidence of VUR in our patient population was substantially lower than in the meta-analysis of Chua etal. and in the study of Kim etal. The explanation for the large discrepancy in VUR incidence may reflect differences in the patient populations, and in our reporting of VUR with respect to kidney number rather than to pelviureteral units. Study limitations include its retrospective nature and potential bias in terms of patient selection. Since VUR is an intermittent phenomenon, sequential rather than simultaneous performance of the ceVUS and fluoroscopic studies might have influenced VUR detection. A blinded comparison of ceVUS performed with Optison™ to fluoroscopic VCUG showed moderate-good sensitivity and specificity for diagnosis of VUR.

Coexistence of Pelviureteric Junction Obstruction and Vesicoureteral Reflux

Introduction: The most common upper urinary tract problem in children is obstruction at the pelviureteric junction. It happens with varying degrees of seriousness. Ultrasonography and DTPA (Diethylene Triamine Penta-acitic Acid) renography are commonly used to detect it. Objective: To find out the coexistence of ipsilateralpelviureteric junction obstruction with vesicourenteral reflux. Materials and Methods: This prospective study was conducted in the Department of Paediatric Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2006 to May 2007 over a period of 1 year 5 months. Thirty-five patients with unilateral hydronephrosis due to PUJ obstruction were included in this study (age: 1 month-15 years). Results were analyzed using Statistical Package for Social Science (SPSS). Results: Incidence of Vesicoureteral reflux (VUR) among pelviureteric junction (PUJ) obstruction patients was 8.6%. Of them Grade-I VUR was 33.3% and grade-II VUR was 66.7%. Mean age of the patients was 4.71 ± 1.97 years and with VUR was 9.33 ± 4.93 years. Male to female ratio was 4:1. Only 5.7% mothers had regular antenatal checkup and 28.5% had irregular. Majority of the patients 28 (80%) were presented with painless loin mass, 6 (17.1%) with fever, 8 (22.9%) with loin pain and 8 (22.9%) with failure to thrive. Three patients (8.6%) showed abnormal R/M/E and all of the abnormal R/M/E samples showed positive culture. Conclusions: Incidence of Vesicoureteral reflux (VUR) among pelviureteric junction (PUJ) obstruction patients was 8.6%. Medicine Today 2021 Vol.33(2): 94-97

Functional results of hautmann neobladder with chimney modification and wallace ureteroileal anastomosis: initial experience with 22 patients.

ABSTRACTObjective:To assess the functional outcomes and complications of modified Hautmann neobladder with Wallace ureteroileal anastomosis on a 6-8 cm long isoperistaltic chimney, following radical cystectomy.Materials and Methods:Between January 2015 and October 2019, 22 patients (18 men and 4 women) underwent radical cystectomy and Hautmann neobladder reconstruction with chimney modification and Wallace I ureteroileal anastomosis. The mean age of patients was 61 years (45–74 years). All procedures were performed by the same surgeon and the mean follow-up was 29.4 months. Complications were registered as early (occurring within 3 months) or late (occurring after 3 months), with particular attention addressed to the ureteroileal anastomotic stricture and anastomotic leakage rate. Patient evaluation also included symptom analysis for daytime continence and voiding frequency.Results:Ureteroileal anastomotic stricture was not detected as a cause of hydronephrosis. Hovewer, the anastomotic leakage occurred in one patient during the early postoperative period. Early complications occurred in 9 patients and the most common was bilateral hydronephrosis, detected in 5 examinees. Late complications occurred in 4 patients. Complete daytime and nighttime continence achieved in 18 and 16 patients respectively, with two patients (9%) still required intermittent catheterization three months after surgery.Conclusions:The functional results with modified Hautmann neobladder, incorporating short afferent limb in Wallace I uretero-enteric anastomosis, were efficient. This technique is an effective way to minimize potential uretero-enteric stricture, anastomotic leakage and incidence of vesicoureteral reflux.

Correlation of anorectal malformation complexity and associated urologic abnormalities

BackgroundPatients with anorectal malformations (ARM) commonly have associated urologic anomalies. Few large studies exist to accurately characterize the incidence or associations between severity of malformation and urologic diagnosis. The purpose of our study was to determine the incidence of urologic diagnoses in a large cohort of children with ARM and evaluate for any correlation between severity of ARM and the incidence and number of associated urologic diagnoses. MethodsA retrospective review was performed of patients with ARM treated at our pediatric colorectal center. All patients underwent protocolized urologic screening. ARM subtypes were ordered with increasing severity as follows in males: perineal, bulbar, prostatic and bladder neck fistulae. Females were similarly categorized as perineal, vestibular and vaginal fistulae followed by cloaca with <3 cm common channel and cloaca with >3 cm common channel. The following urologic diagnoses were assessed to determine whether a correlation existed with the severity of the ARM subtype: hydronephrosis, vesicoureteral reflux (VUR), solitary kidney, renal ascent anomalies (ectopic or pelvic), renal fusion anomalies (horseshoe or cross fused kidney), duplex kidney, hypospadias and undescended testicle. ARM subtypes were defined by distal rectal anatomy. ResultsA total of 712 patients were included in our study with a mean age of 4 years and of whom 45% were male. The overall rate of urologic anomalies was greater in males than females (65% vs 56% p < 0.026). In both sexes, the rate of urologic anomalies increased with increasing severity of ARM subtype (p<0.00010) finding that males with bladder neck fistula and females with cloacal malformations, particularly with long common channels, being the highest incidence. In males and females, the rate of hydronephrosis increased as the complexity of ARM increased and this correlated significantly (p < 0.0001 vs p < 0.0003 respectively). Similarly, the incidence of VUR also increased as complexity of ARM increased in both males and females (p = 0.01 and p<0.0001 respectively). The remaining urologic diagnoses were not significantly correlated with severity of ARM. ConclusionsUrologic anomalies occur at a high rate in children with ARM and appear to increase in frequency with increasing complexity of ARM subtype. These findings stress the importance of proper ARM screening and proactive collaboration with a clinician with expertise in pediatric urology early in the management of such children to improve early recognition of urologic diagnoses. Level of evidenceLevel III.

Çocuklarda Vezikoüreteral Reflü ve Mesane Volümüyle İlişkili Yeni Bir Radyolojik Belirti: Klinik Çalışma

Objective: The aim of the current study was to investigate demographic, clinical and radiological factors prone to influence urinary bladder volume in vesicoureteral reflux with special attention to hypoplasia of the 5th lumbar vertebra. Material and Methods: This retrospective study was performed using data derived from pediatric patients who were admitted to the pediatric urology department of our tertiary care center between 2010 and 2015 with complaints consistent with vesicoureteral reflux. A total of 104 children were subgrouped into two according to age (<72 months and ≥72 months). Demographic data, clinical findings, radiological data including hypoplasia of the fifth lumbar vertebra and results derived from voiding cystourethrogram, scintigraphy and ultrasonography were gathered and analyzed. Results: In children <72 months, incidence of vesicoureteral reflux was remarkably higher and volume of urinary bladder was significantly increased in children with diminished height of 5th lumbar vertebra corpus (p<0.001). On the other hand, findings derived from scintigraphy and ultrasonography were not different in patients with diminished height of 5th lumbar vertebra corpus. In children ≥72 months, frequency of vesicoureteral reflux was notably higher in children with lower height of vertebral body corpus (p=0.001). However, there was no difference between children with normal and decreased 5th lumbar vertebra corpus in terms of urinary bladder volumes (p=0.970). Conclusion: We suggest that hypoplasia of 5th lumbar vertebra can be a novel and practical radiological clue that may aid in the diagnosis of vesicoureteral reflux in children. However, further controlled trials on larger series are essential for understanding its clinical significance.

OUR EXPERIENCE WITH CONTRAST-ENHANCED VOIDING UROSONOGRAPHY.

SUMMARYVesicoureteral reflux (VUR) is one of the most common anomalies of the urinary system in children. Contrast-enhanced voiding urosonography (ceVUS) is one of the best methods in VUR diagnosis. This study compared characteristics associated with VUR specific images and categorized patients according to a particular VUR grade. The study included 183 children. VUR was detected in 38.9% of patients, mean age 1.7±1.1 years. Grade II VUR was most common (60.3%), followed by grade III (29.4%). Study results showed that VUR occurred irrespective of age, gender, previous ultrasound findings, causative agent, and severity of urinary tract infection (UTI). VUR was more common in children with recurrent UTI. In the group of children with the first UTI not caused by Escherichia coli or with recurrent UTI, boys more commonly suffered from severe VUR (grade IV-V; 66.7%), while girls suffered from moderate VUR (grade II-III; 100%). In this study, the incidence of VUR in prenatally diagnosed hydronephrosis was 28.6%. It is necessary to develop an algorithm for the treatment of children after UTI in Croatia, which should include ceVUS. All children with possible VUR should be referred to a specialized center where it is possible to perform ceVUS.

Effectiveness of endoscopic treatment of duplex system ureteroceles in children

Objective. The aim of this study is to evaluate the efficiency of transurethral incision of ureteroceles and incidence of vesicoureteral reflux in pediatric patients with duplex system ureterocele.&#x0D; Materials and methods. This is a retrospective study of 155 pediatric patients with duplex system ureterocele. The age of patients at the time of surgery ranged from 5 days to 17 years (median 8.0 months). Intravesical ureterocele had 108 patients (69.8%), extravesical 47 (30.2%).&#x0D; Results. Complications occurred in 2 patients (1.3%), recurrence obstruction was in 1 case (0.6%). Ipsilateral vesicoureteral reflux after surgery had 112 patients (72.3%): in the upper pole 51 cases (32.9%), in the lower pole 32 (20.6%), in both ureters 29 (18.7%). In the long-term period after transurethral incision of ureteroceles 97 patients (62.5%) needed reoperation due to infection and voiding dysfunction. Statistically significant risk factors associated with the need for reoperation were the presence of vesicoureteral reflux on the ureteroceles side and non-functioning upper pole of the kidney.&#x0D; Conclusion. Transurethral incision of ureteroceles for duplex system ureterocele is a safe and effective minimally invasive method of primary resolving of the obstruction. Vesicoureteral reflux on the ureterocele side after surgery had 72.3% of patients; reoperation in the long term was necessary in 62.5% cases. The main risk factor reoperation is vesicoureteral reflux on the ureterocele side.

Incidence of vesicoureteral reflux in children with urinary tract infections

Incidence of vesicoureteral reflux in children with urinary tract infections

Incidence of primary vesicoureteral reflux in patients with febrile convulsions.

The aim of this study is to evaluate the incidence of vesicoureteral reflux (VUR) in patients with febrile convulsion (FC). For this, patients that were diagnosed with FC in 2018 were retrospectively reviewed. Those with epilepsy, motor/mental retardation, or spina bifida were excluded. Mid-stream urine samples were collected in children who were toilet trained while sterile bags were used in the smaller. Urinary tract infection (UTI) was defined as ˃ 5 leucocytes/HPF in urinalysis and a subsequent positive urine culture (≥ 10.000 CFU/ml). Children with UTI were further investigated via voiding cystourethrogram (VCUG) and dimercaptosuccinic acid (DMSA) scintigraphy for VUR. Urinalysis was present in 79 among a total of 181 patients (43.6%). Forty-five of the patients were male (57%). Mean age was 2.6 ± 1.4 years. UTI was diagnosed in 6 (7.6%) patients (5 females, 1 male). Three of the girls had recurrent febrile UTI and subsequently, VUR was diagnosed in two of them. VUR is found in 2.5% of the FC cases with urine sampling. Urinalysis should not be ignored in patients with FC as it may lead to diagnosis of VUR.

Management of urinary tract infections in children: antimicrobial sensitivity pattern, efficacy and pharmacoeconomics

Background: Urinary tract infections are commonly seen in febrile children, high incidence of Vesico Ureteral Reflux (VUR) is frequently seen in paediatric patient which is of concern as it may lead to renal scarring. Despite presence of established clinical guidelines there is disparity amongst physician in the diagnosis and treatment of UTI, some physician prescribes taking into consideration the symptoms, some prescribe on the basis of smell and colour and some rely on urine culture and sensitivity report. There is dearth of studies in many tertiary health care centers regarding antimicrobial use. Authors conducted this study to evaluate antimicrobial sensitivity pattern, efficacy and cost effectiveness of antimicrobials used for UTI in children.Methods: Patients of urinary tract infection &lt;13 years of age were included in the study. Symptoms of patient i.e. pain in abdomen, haematuria, increased frequency of urination and degree of fever were recorded. Efficacy was measured through calculating degree of defervescence per hour. Cost effective model was prepared by calculating cost effective ratio i.e. dividing cost of antimicrobial required to bring down the fever and degree through which fever came down.Results: E. coli was the most common pathogen isolated from urine positive culture (69.07%). Nitrofurantoin has shown highest sensitivity to all uropathogens (72.73%). Cotrimoxazole, ciprofloxacin and nitrofurantoin were found to be most cost effective.Conclusions: In this current study authors found E coli is the most common uropathogen isolated. Ceftriaxone, cefixime, cotrimoxazole and amikacin were found to be most efficacious. Cotrimoxazole, ciprofloxacin and nitrofurantoin were found to be most cost effective.

The effect of onabotulinumtoxinA according to site of injection in patients with overactive bladder: a systematic review and meta-analysis.

This study assessed the efficacy and safety of onabotulinumtoxinA according to injection site for treatment of overactive bladder. A systematic literature review located randomized controlled trials of onabotulinumtoxinA treatment for neurogenic detrusor overactive bladder and idiopathic overactive bladder in adults. We searched MEDLINE, EMBASE, and the Cochrane Controlled Trials Register using the Ovid platform. Meta-analysis was based on Cochrane Review Methods. Eight studies (419 participants) were included. Trigone-including injection demonstrated a significant improvement in symptom score (SMD=-0.53, 95% CI -1.04 to -0.02, P=0.04, I 2=78%), higher complete dryness rates (OR=2.19 patients, 95% CI 1.32-3.63, P=0.002, I 2=41%), and lower frequency of incontinence episodes (WMD=-0.85 per day, 95% CI -1.55 to -0.16, P=0.02, I 2=87%) in patients. Comparing trigone-including injection to trigone-sparing injection, lower detrusor pressure (WMD=-2.55cm H2O, 95% CI -4.16 to -0.95, P=0.002, I 2=0%) and higher volume at first desire to void (WMD=17.54ml, 95% CI 1.00-34.07, P=0.04, I 2=0%) were observed with trigone-including injection. Between intradetrusor and suburothelial injection sites, there were no differences in efficacy or safety regarding the incidence of vesicoureteral reflux, hematuria, general weakness, bladder discomfort, large post-void residual, and urinary tract infection. Trigone-including onabotulinumtoxinA injection has superior efficacy to trigone-sparing injection without increased complications. The depth of injection does not influence the efficacy or safety of onabotulinumtoxinA.

Impact of Clinical Guidelines on Voiding Cystourethrogram Use and Vesicoureteral Reflux Incidence

To prevent over diagnosis and overtreatment of vesicoureteral reflux the 2007 NICE (National Institute for Health and Care Excellence) and 2011 AAP (American Academy of Pediatrics) guidelines recommended against routine voiding cystourethrograms in children presenting with first febrile urinary tract infections. The impact of these guidelines on clinical practice is unknown. Using an administrative claims database (Clinformatics™ Data Mart) children who underwent voiding cystourethrogram studies or had a diagnosis of vesicoureteral reflux between 2001 and 2015 were identified. The cohort was divided into children age 0 to 2 and 3 to 10 years. Single and multiple group interrupted time series analyses (difference-in-difference) were performed with the guidelines as intervention points. The incidence of vesicoureteral reflux was compared across each period. Of the 51,649 children who underwent voiding cystourethrograms 19,422 (38%) were diagnosed with vesicoureteral reflux. In children 0 to 2 years old voiding cystourethrogram use did not decrease after the 2007 NICE guidelines were announced (-0.37, 95% CI -1.50 to 0.77, p = 0.52) but did decrease significantly after the 2011 AAP guidelines were announced (-2.00, 95% CI -3.35 to -0.65, p = 0.004). Among children 3 to 10 years old voiding cystourethrogram use decreased during the entire study period. There was a decrease in the incidence of vesicoureteral reflux in both groups that mirrored patterns of voiding cystourethrogram use. The 2011 AAP guidelines led to a concurrent decrease in voiding cystourethrogram use and incidence of vesicoureteral reflux among children 0 to 2 years old. Further studies are needed to assess the risks and benefits of reducing the diagnosis of vesicoureteral reflux in young children.

Heterozygous loss-of-function mutation in Odd-skipped related 1 (Osr1) is associated with vesicoureteric reflux, duplex systems, and hydronephrosis.

Odd-skipped related 1 (Osr1) is a transcriptional repressor that plays critical roles in maintaining the mesenchymal stem cell population within the developing kidney. Here, we report that newborn pups with a heterozygous null mutation in Osr1 exhibit a 21% incidence of vesicoureteric reflux and have hydronephrosis and urinary tract duplications. Newborn pups have a short intravesical ureter, resulting in a less competent ureterovesical junction which arises from a delay in urinary tract development. We describe a new domain of Osr1 expression in the ureteral mesenchyme and within the developing bladder in the mouse. OSR1 was sequenced in 186 children with primary vesicoureteric reflux, and 17 have single nucleotide polymorphisms. Fifteen children have a common synonymous variant, rs12329305, one child has a rare nonsynonymous variant, rs3440471, and one child has a rare 5'-UTR variant, rs45535040 The impact of these SNPs is not clear; therefore, the role of OSR1 in human disease remains to be elucidated. Osr1 is a candidate gene implicated in the pathogenesis of vesicoureteric reflux and congenital abnormalities of the kidney and urinary tract in mice.

MP79-20 THE IMPACT OF URETERAL COMPLICATIONS AFTER PEDIATRIC RENAL TRANSPLANTATION

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery I1 Apr 2015MP79-20 THE IMPACT OF URETERAL COMPLICATIONS AFTER PEDIATRIC RENAL TRANSPLANTATION Julia B. Finkelstein, Jamie S. Pak, Jennifer J. Ahn, Jason P. Van Batavia, Mark V. Silva, Namrata G. Jain, and Shumyle Alam Julia B. FinkelsteinJulia B. Finkelstein More articles by this author , Jamie S. PakJamie S. Pak More articles by this author , Jennifer J. AhnJennifer J. Ahn More articles by this author , Jason P. Van BataviaJason P. Van Batavia More articles by this author , Mark V. SilvaMark V. Silva More articles by this author , Namrata G. JainNamrata G. Jain More articles by this author , and Shumyle AlamShumyle Alam More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2877AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES After renal transplantation, the incidence of acute graft rejection has declined with advances in immunosuppressive regimens, making the evaluation of other risk factors for graft failure vital. Urologic issues and, in particular, ureteral complications (UC) are associated with increased patient and graft morbidity. We sought to investigate the incidence of UC and to assess their impact on post-transplant outcomes. METHODS We retrospectively reviewed 49 pediatric patients who underwent 57 renal transplants at a single institution from 2004 to 2014. 90% of patients had a Lich-Gregoire ureterocystostomy and 61% underwent ureteral stenting. We evaluated the incidence of UC, defined as vesicoureteral reflux (VUR), stricture, or obstruction, and compared the post-transplant outcomes of children with UC to those without known UC. Fisher's exact and Mann-Whitney U tests were performed for statistical analysis. RESULTS A screening post-transplant urodynamic study or VCUG was performed in 25 children. VUR was detected in 22 patients. The incidence of VUR in the other 24 recipients is not known. There were also 5 cases of strictures and 2 of obstruction. Overall, 29 UC were encountered in 24 patients (49%). There was no difference between groups in deceased versus living donor (p=0.91), warm ischemia time (p=0.51) or ureteral stenting (p=0.21). Children with UC were significantly more likely to be male (p=0.021), require a nephrostomy tube (p=0.050), develop UTIs (p<0.0001), and be hospitalized (p=0.0002). 95% of children with UC had creatinine values elevated from nadir (increase range 0.3-1.9 mg/dL). To date, 7 patients (29%) underwent 10 operations to treat UC. CONCLUSIONS Although only 25 children had urologic studies post-transplant, almost half of our renal transplant recipients had UC. These complications carried significant morbidity, with 58% of children having UTIs and 29% requiring surgery. The rise, sometimes markedly, in creatinine from nadir is concerning. Moreover, 88% of studies showed pathology, indicating the importance of post-transplant urologic evaluation. Interventions/Complications # Without Known UC (n=25) # With UC (n=24) p-value Nephrostomy Tube 0 4 (17%) 0.050 Urinary Tract Infections 0 14 (58%) <0.0001 Median Post-Transplant Admissions (IQR) 1 (0-3) 6 (3.5-11) 0.0002 Transplant Biopsy 10 (40%) 14 (67%) 0.088 Graft Rejection 7 (28%) 11 (46%) 0.244 Graft Failure 4 (16%) 3 (13%) 1.00 Creatinine Trend (change from nadir level) # of UC Patients (n=22) No change 1 (4.5%) Increased by: 50% 6 (27.3%) 100% 9 (41.0%) 200% 4 (18.2%) 400% 1 (4.5%) 700% 1 (4.5%) © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1018 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Julia B. Finkelstein More articles by this author Jamie S. Pak More articles by this author Jennifer J. Ahn More articles by this author Jason P. Van Batavia More articles by this author Mark V. Silva More articles by this author Namrata G. Jain More articles by this author Shumyle Alam More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Evaluation of new American Academy of Pediatrics guideline for febrile urinary tract infection

PurposeTo evaluate the practical applications of the diagnosis algorithms recommended by the American Academy of Pediatrics urinary tract infection (UTI) guideline.MethodsWe retrospectively reviewed the medical records of febrile UTI patients aged between 2 and 24 months. The patients were divided into 3 groups: group I (patients with positive urine culture and urinalysis findings), group II (those with positive urine culture but negative urinalysis findings), and group III (those with negative urine culture but positive urinalysis findings). Clinical, laboratory, and imaging results were analyzed and compared between the groups.ResultsA total of 300 children were enrolled. The serum C-reactive protein level was lower in children in group II than in those in groups I and III (P<0.05). Children in group I showed a higher frequency of hydronephrosis than those in groups II and III (P<0.05). However, the frequencies of acute pyelonephritis (APN), vesicoureteral reflux (VUR), renal scar, and UTI recurrence were not different between the groups. In group I, recurrence of UTI and presence of APN were associated with the incidence of VUR (recurrence vs. no recurrence: 40% vs.11.4%; APN vs. no APN: 23.3% vs. 9.2%; P<0.05). The incidence of VUR and APN was not related to the presence of hydronephrosis.ConclusionUTI in febrile children cannot be ruled out solely on the basis of positive urinalysis or urine culture findings. Recurrence of UTI and presence of APN may be reasonable indicators of the presence of VUR.

Postnatal longitudinal evaluation of children diagnosed with prenatal hydronephrosis: insights in natural history and referral pattern

Clinical significance and management of prenatal hydronephrosis (PNH) are sources of debate. Existing studies are flawed with biased cohorts or inconsistent follow-up. We aimed to evaluate the incidence of pathology in a large cohort of PNH and assess the biases and outcomes of this population. We reviewed 1034 charts of fetuses with PNH. Records of delivered offspring were reviewed at a pediatric center and analyzed with respect to prenatal and postnatal pathology and management. Prenatal resolution of hydronephrosis occurred in 24.7% of pregnancies. On first postnatal ultrasound, some degree of dilatation was present in 80%, 88% and 95% of mild, moderate and severe PNH cases, respectively. At the end of follow-up, hydronephrosis persisted in 10%, 25% and 72% of children, respectively. Incidence of vesicoureteral reflux did not correlate with severity of PNH. Children with postnatal workup had more severe PNH than those without. Despite prenatal resolution totalizing 25%, pelvic dilatation persisted on first postnatal imaging in most cases, thus justifying postnatal ultrasound evaluation. Whereas most mild cases resolved spontaneously, a quarter of moderate and more than half of severe cases required surgery. Patients with postnatal imaging and referral had more severe PNH, which could result in overestimation of pathology.

Kidney Ultrasonography and Dimercaptosuccinic Acid Scans for Revealing Vesicoureteral Reflux in Children With Pyelonephritis: A 7-Year Prospective Cohort Study of 1500 Pyelonephritic Patients and 2986 Renal Units

Background: The presence of vesicoureteral reflux (VUR) has been documented in 1.3% of the general population, 70% of infants with urinary tract infection (UTI), and 15–25% of children with UTI. Objectives: The main aims of this prospective cohort study were to compare the efficiency of different imaging techniques [renal ultrasonography, cortical scintigraphy with technetium-99m dimercaptosuccinic acid (99mTc DMSA)] in detecting VUR in patients with acute pyelonephritis. Patients and Methods: Between June 2003 and March 2010, we recruited a prospective cohort of patients aged 1 month to 14 years. Pediatric patients with documented urinary tract infections and imaging evidence of upper tract involvement were examined by DMSA scintigraphy, renal ultrasonography, and voiding cystourethrography (VCUG). The assessments included UTI profiling, kidney ultrasonography, and DMSA scans. Data were expressed as mean ± SD. Statistical tests were two-tailed and were considered significant when P ≤ 0.05. Results: A total of 1500 pediatric patients were eligible to receive treatment for pyelonephritis. DMSA scans were normal in 20.2% of the patients and abnormal in the remaining 79.8%, and the kidney ultrasonographies yielded normal results in 68.5% of the patients and abnormal results in the remaining 31.5%. There was a significant difference between the ultrasonography reports of patients with normal and abnormal DMSA scans. The VCUG results were normal in 74.1% of the patients and indicated VUR in the remaining 25.9% (VUR grade I in 10.7%, grade II in 7.3%, grade III in 4.7%, grade IV in 1.7%, and grade V in 1.5%). The refluxes were unilateral in 62.9% of the patients and bilateral in the remaining 37.1%. We found a significant correlation between the presence of VUR in VCUG and urological abnormality in ultrasonography (r = 0.14, P < 0.001). The incidence of VUR among patients showing severe abnormalities in DMSA scintigraphy, was significantly higher than that among patients with normal DMSA results or those showing mild to moderate changes in DMSA scintigraphy. Conclusions: We concluded that kidney ultrasonography and DMSA scans can be performed before VCUG in children with UTI. In addition, we recommend performing VCUG in cases of pyelonephritis only when the patients show abnormal kidney ultrasonography or DMSA scan results.

Evaluation of the clinical and imaging examination in high-risk children with vesicoureteral reflux

To analyze the clinical data and result of voiding cystourethrography (VCUG) in high-risk children with vesicoureteral reflux (VUR) for better awareness of VUR, and to assess the usefulness of non-radioactive voiding ultrasonography (VUS) in the diagnosis of VUR. Ninety-three high-risk children with VUR who were hospitalized from July 2007 to April 2010 were studied. The study included 58 cases of urinary tract infection (UTI) and 35 cases of fetal or postnatal hydronephrosis detected on a B ultrasound scan. The results of urinalysis, urine culture, renal function, B ultrasound and VCUG were evaluated. Part of patients underwent VUS followed by VCUG immediately. (1) Sixty-two boys and 31 girls (aged 1 month to 11.5 years, mean age 2 years) were included. VUR was detected in 26 patients (28%) by VCUG. In terms of kidney-ureter units, VUR was detected in 36 of 186 kidney-ureter units, including 6 grade I, 3 grade II, 6 grade III, 15 grade IV and 6 grade V. (2) VUR was detected in 20 of 58 UTI patients (34.5%) by VCUG. The proportion of VUR in recurrent UTI group was 61.1%, much higher than that in first UTI group (22.5%). Thirteen of 20 VUR (65%) occurred in UTI patients under 1 year of age (M/F 10/3), with more bilateral VUR and severe grades of VUR than the older group. VUR was detected in 6 of 35 fetal or postnatal hydronephrosis patients (17.1%) by VCUG. (3) Twenty-two patients underwent both VUS and VCUG. VUR was detected in 4 patients and 6 kidney-ureter units by VCUG, while in 6 patients and 9 kidney-ureter units by VUS. Taking VCUG as the reference standard, VUS had a sensitivity of 100%, specificity of 92.1%, positive predictive value of 66.7%, and negative predictive value of 100%. There was a concordance rate of 93.2% between VUS and VCUG. It is important to early screen VUR in UTI, fetal or postnatal hydronephrosis patients. There are more VUR, especially more bilateral VUR and severe grades of VUR, occurred in UTI patients under 1 year of age compared to older children. The incidence of VUR in recurrent UTI group was much higher than that in first UTI group. VUS is an accurate, reliable and radiation-free technique for the detection of VUR. It could be used to screen high-risk children for VUR and do the evaluation in the follow-up of VUR.

Primary Vesico-Ureteral Reflux: Comparison of Factors between Infants and Children

PurposeThe association of age, sex and renal parenchymal damage (RPD) in vesicoureteral reflux (VUR) is well known. We compared various factors between infants and children in a cohort of patients with primary VUR.Materials and MethodsMedical records of 147 patients diagnosed as VUR between 1997 and 2010 were reviewed. Of these children 91 (61.9%) were boys and 56 (38.1%) were girls. 99 (67.3%) of the 147 patients were younger (Group 1), and 48 (32.7%) were older than 1 year (Group 2). The impact of patient's gender and age as well as VUR grade on RPD were analyzed in each patient. The Fisher's exact test and chi square test was done with SPSS ver. 12.0 (SPSS Inc., Chicago, IL, USA).ResultsVUR was unilateral in 88 patients (59.9%) and bilateral in 59 patients (40.1%). Abnormal renal scan was found in 78 (37.7%) renal units. The incidence of VUR was significantly higher in male in group 1 (p<0.01) and in female in group 2 (p<0.01). The incidence of abnormal renal scan was significantly higher in intermediate and high grade VUR comparing low grade VUR in group 1 (p=0.042). In both group, abnormal renal scan didn't show any difference between male and female statistically (p>0.05).ConclusionsOur data showed that VUR in infant was significantly higher in male than in female, whereas VUR in children was significantly higher in female. This may be due to that characteristic of a population where neonatal circumcision is not a common procedure in infant and urinary tract infections are more common in female children. Further study may be needed to identify gender difference in RPD in infant with high grade reflux.