Friday, July 13, 2012

Vesicoureteral Reflux Screening of No Help in Some Infant Candidates


NEW YORK (Reuters Health) Jul 02 - In children with low-grade hydronephrosis and otherwise normal kidneys and bladder, there might be no point to vesicoureteral reflux screening, Canadian researchers say.
Dr. John-Paul Capolicchio and colleagues at McGill University Health Center in Montreal say vesicoureteral reflux may be fairly prevalent in urologically normal children and may often have a benign course.
And the main test for vesicoureteral reflux - voiding cystourethrography (VCUG) - is invasive and painful, even traumatic, in youngsters.
In a June 14th online paper in The Journal of Urology they reviewed data on 206 children with hydronephrosis but without renal or bladder anomalies. The condition had been detected before the children were born.
Most (148) had grade I or II hydronephrosis. VCUG was performed in 66.2% of the low grade group and in all but one of the kids with grade III or IV disease.
The mean follow-up was 20 months in the low-grade group and 30 months in the high-grade group.
Overall, the rate of urinary tract infection (UTI) was 3.52 per 100 patient-years in children with low grade hydronephrosis (although none of the 42 patients with grade I hydronephrosis had a UTI) and 11.1 per 100 patient-years in those with high grade hydronephrosis.
This difference persisted after correcting for gender and circumcision status and almost reached significance after correcting for vesicoureteral reflux status. No difference was seen in the incidence of UTIs between those with low grade hydronephrosis who were screened and those who were not.
"Our results" the researchers conclude, "confirm the low incidence of UTIs in children with low grade hydronephrosis, especially grade I, and do not support a policy of routine screening for reflux."
Dr. Capolicchio did not respond to requests for comments.
J Urol 2012.

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