PURPOSE: Recurrent febrile urinary tract infections (fUTIs) in children with non-diagnostic voiding cystourethrogram (VCUG) are challenging, as misdiagnosis can lead to renal damage and increased morbidity.
We compared fUTI rates before and after endoscopic treatment of patients with suspected occult VUR.
METHODS: Between January 2009 and December 2012, children with history of fUTI and non-diagnostic VCUG(s) underwent endoscopic ureteral hydrodistention (HD) and injection of dextranomer hyaluronic acid co-polymer (Dx/HA). fUTI rates before and after intervention were evaluated. Demographics, imaging and endoscopic findings were assessed.
RESULTS: Thirty-four children (mean age 5.4±2.8 years) underwent bilateral Dx/HA injection for occult VUR. Average follow-up was 28.8 months. Seventeen children had renal scarring. Mean ureteral HD grade was 2.2/3. HD grade for ureters associated with renal scarring was significantly (p< 0.05) higher (2.6/3) than those without scarring (2.0/3). Mean injected volume was 1.2 mL. Ureters associated with renal scarring (n=21) required significantly (p<0.05) higher volumes (1.4 mL) than those without scarring (n=47; 1.1 mL). Prior to intervention, the fUTI rate was 0.15/patient/month compared to just 0.02 after treatment (p< 0.0001).
CONCLUSIONS: Incidence of fUTIs significantly decreased following treatment, supporting the use of Dx/HA injection in carefully selected children when the suspicion for occult VUR is high.
Written by:
Arlen AM, Broderick KM, Leong T, Dewhurst LL, Filimon E, Weiss AD, Kirsch AJ. Are you the author?
Department of Pediatric Urology, Emory University, Children's Healthcare of Atlanta, Atlanta, GA, USA; Children's Healthcare of Atlanta and Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University School of Medicine, Atlanta, GA, USA. ;
Reference: J Pediatr Urol. 2014 Dec;10(6):1095-9.
doi: 10.1016/j.jpurol.2014.03.016
PubMed Abstract
PMID: 24916577