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Vesicoureteral reflux: current trends in diagnosis, screening, and treatment
Jonathan C Routh1, Guy A Bogaert, Martin Kaefer
1Division of Urologic Surgery, Duke University Medical Center, Durham, NC 27710, USA. jonathan.routh@duke.edu
Insights
Vesicoureteral reflux (VUR) affects 1% of children and can lead to kidney damage. Current VUR diagnosis and treatment guidelines lack strong evidence, necessitating further research for better patient outcomes.
Area of Science:
- Pediatric Nephrology
- Urology
Background:
- Vesicoureteral reflux (VUR) affects approximately 1% of children in North America and Europe.
- VUR is linked to an increased risk of pyelonephritis and renal scarring.
- Despite its prevalence, VUR management remains controversial.
Purpose of the Study:
- To review current evidence on controversial aspects of VUR diagnosis, screening, and treatment.
- To identify areas needing further research in VUR management.
Main Methods:
- Systematic review of multiple databases (Medline, Embase, Cochrane, etc.).
- Inclusion of recent guidelines from relevant medical specialty organizations.
Main Results:
- Published data on VUR screening, diagnosis, and treatment controversies were objectively assessed.
- Focus on recent areas of debate in VUR management.
Conclusions:
- The evidence supporting current VUR management practices is limited.
- Future research should focus on identifying at-risk children, stratifying treatment options, and reporting long-term outcomes.
Context:
Vesicoureteral reflux (VUR) is present in approximately 1% of children in North America and Europe and is associated with an increased risk of pyelonephritis and renal scarring. Despite its prevalence and potential morbidity, however, many aspects of VUR management are controversial.
Objective:
Review the evidence surrounding current controversies in VUR diagnosis, screening, and treatment.
Evidence Acquisition:
A systematic review was performed of Medline, Embase, Prospero, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, clinicaltrials.gov, and the most recent guidelines of relevant medical specialty organizations.
Evidence Synthesis:
We objectively assessed and summarized the published data, focusing on recent areas of controversy relating to VUR screening, diagnosis, and treatment.
Conclusions:
The evidence base for many current management patterns in VUR is limited. Areas that could significantly benefit from additional future research include improved identification of children who are at risk for VUR-related renal morbidity, improved stratification tools for determining which children would benefit most from which VUR treatment option, and improved reporting of long-term outcomes of VUR treatments.
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