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Controversies in the management of vesicoureteral reflux: the rationale for the RIVUR study

Ranjiv Mathews1, Myra Carpenter, Russell Chesney

  • 1Division of Pediatric Urology, The Johns Hopkins School of Medicine, Baltimore, MD 21287, USA. rmathew1@jhmi.edu

Journal of Pediatric Urology
|July 3, 2009
PubMed

Insights

Antibiotic prophylaxis may not prevent urinary tract infections (UTIs) or renal scarring in children with vesicoureteral reflux (VUR). Further research is needed to determine the benefits of VUR identification and management.

Area of Science:

  • Pediatric Nephrology
  • Urology

Background:

  • Current management of vesicoureteral reflux (VUR) prioritizes UTI prevention via prophylactic antibiotics.
  • This approach assumes UTIs and subsequent renal scarring are preventable, and that VUR may resolve spontaneously.

Purpose of the Study:

  • To critically evaluate the efficacy of antibiotic prophylaxis in preventing UTIs and renal scarring in children with VUR.
  • To review current controversies surrounding VUR management.

Main Methods:

  • Literature review of recent studies on VUR management.
  • Discussion of the ongoing RIVUR (Reflux in VUR) Study, a randomized placebo-controlled trial by the National Institutes of Health.

Main Results:

  • Growing concern exists that antibiotic prophylaxis may not effectively prevent UTIs in children with VUR.
  • Evidence suggests renal scarring may not be preventable with antibiotic prophylaxis or surgical correction.

Conclusions:

  • The RIVUR Study's outcomes will have significant implications for VUR management.
  • If antibiotic prophylaxis is ineffective, the necessity of VUR identification and its benefits require re-evaluation.
  • Prompt and appropriate treatment of UTIs may be sufficient for preserving renal function.
Abstract

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