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Published on: October 12, 2017
Vesicoureteral reflux is a phenotype, not a disease: A population-centered approach to pediatric urinary tract
Jathin Bandari1, Steven G Docimo1
1Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Insights
Routine evaluation for vesicoureteral reflux (VUR) is unnecessary for most children with urinary tract infections (UTIs). VUR often has no impact on UTI management or outcomes, and its absence may hinder beneficial treatments.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Urology
Background:
- Urinary tract infections (UTIs) are common in children.
- Vesicoureteral reflux (VUR) has historically been a focus in UTI evaluation.
- Optimal management strategies for pediatric UTIs are continually evolving.
Purpose of the Study:
- To review current literature on pediatric UTI evaluation and management.
- To assess the clinical significance of VUR in the context of UTI management.
- To propose revised guidelines for VUR evaluation in children with UTIs.
Main Methods:
- Comprehensive literature review of recent studies on pediatric UTIs.
- Analysis of management strategies and outcomes related to VUR.
- Synthesis of evidence to determine the necessity of VUR screening.
Main Results:
- Vesicoureteral reflux (VUR) is inconsequential in most children with UTIs.
- The presence or absence of VUR does not influence optimal UTI management or patient outcomes.
- Knowledge of VUR status may negatively impact treatment decisions, potentially withholding beneficial therapies like antibiotic prophylaxis.
Conclusions:
- Routine evaluation for VUR in children with UTIs is not recommended.
- VUR assessment is only warranted in a small subset of children with refractory UTIs.
- Focus should be on managing other risk factors and appropriate UTI treatment rather than VUR screening.
Abstract:
We performed a review of the recent literature concerning urinary tract infection (UTI) evaluation and management. In modeling options for management, one overriding conclusion became apparent: in most affected children, the presence of vesicoureteral reflux (VUR) is inconsequential since it has no bearing on optimal management or outcome. In fact, knowing that a child does not have reflux might bias the provider to withhold potentially helpful therapeutic modalities to decrease UTI morbidity, such as antibiotic prophylaxis. In this review, we will propose that evaluation for VUR is not necessary or helpful except in the small subset of children whose UTIs have proven refractory to management of their other risk factors.
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