Prophylaxis Versus No Prophylaxis for Reflux

Skoog, Steven J.; Steinhardt, George F.

doi:10.1016/j.juro.2012.01.023

Cited by 5 publications

(5 citation statements)

References 8 publications

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“…14 Antibiotic prophylaxis might be particularly appropriate in patients younger than 1 year of age as in this age group UTI are more difficult to diag nose, can develop quickly, can be particularly severe and are likely to cause renal injury and recur. 14 Nevertheless, although several studies (including randomized clinical trials) have assessed the role of antibiotic prophylaxis in patients with primary VUR, [15][16][17] very few studies have specifically focused on the role of antibiotic prophy laxis in patients with nonrefluxing upper urinary tract dilatation or uretero cele. [18][19][20][21][22] Furthermore, the role of anti biotic prophylaxis in treating patients with primary VUR remains under scrutiny.…”

Section: Introductionmentioning

confidence: 99%

“…[18][19][20][21][22] Furthermore, the role of anti biotic prophylaxis in treating patients with primary VUR remains under scrutiny. 15,16 Indeed, several meta analyses of recent trials showed the ineffectiveness of antibiotic prophylaxis in preventing UTI recurrence, and concern mounts regarding its potential drawbacks. [15][16][17] For example, antibiotic prophylaxis might favour selec tion of antibioticresistant bacterial strains, is poorly accepted by parents and increases the healthcare burden (Box 1).…”

Section: Introductionmentioning

confidence: 99%

“…15,16 Indeed, several meta analyses of recent trials showed the ineffectiveness of antibiotic prophylaxis in preventing UTI recurrence, and concern mounts regarding its potential drawbacks. [15][16][17] For example, antibiotic prophylaxis might favour selec tion of antibioticresistant bacterial strains, is poorly accepted by parents and increases the healthcare burden (Box 1). 23,24 In this Review, we critically assess the available data on the role of antibiotic prophylaxis in the conservative manage ment of hydronephrosis, PNRM and ureterocele.…”

Section: Introductionmentioning

confidence: 99%

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Antibiotic prophylaxis in antenatal nonrefluxing hydronephrosis, megaureter and ureterocele

Castagnetti

Cimador

Esposito³

et al. 2012

Nat Rev Urol

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Observation is a conservative management option in infants with nonrefluxing hydronephrosis, primary nonrefluxing megaureter and ureterocele diagnosed postnatally following antenatal detection of hydronephrosis. Antibiotic prophylaxis might be a sensible regimen under these circumstances to prevent UTI in this population who are potentially at increased risk. However, studies examining the efficacy of prophylactic antibiotics are sparse in this setting. For each condition, prophylactic policies seem extremely variable, and UTI rates vary widely with comparable rates reported between patients followed on and off antibiotics. Overall, antibiotic prophylaxis seems unnecessary in patients with isolated low-grade hydronephrosis. Patients with high-grade nonrefluxing hydronephrosis seem at increased risk of UTI, with risk further increasing in patients with associated ureteral dilatation (hydroureteronephrosis) irrespective of the presence of a ureterocele. Obstruction might be an additional independent risk factor, but the diagnosis of obstruction is often possible only in retrospect. The data available suggest that infants are the most at risk of UTI during the first 6 months of life, particularly if they undergo catheterization during workup examinations. Thus, antibiotic prophylaxis might be prudent during the first 6-12 months of life in patients with high-grade hydronephrosis and hydroureteronephrosis with or without ureterocele, and particularly before completion of the diagnostic workup. Paediatric urologists are urged to embark on controlled trials to compare patients followed with and without antibiotic prophylaxis.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Antibiotic prophylaxis in antenatal nonrefluxing hydronephrosis, megaureter and ureterocele

Castagnetti

Cimador

Esposito³

et al. 2012

Nat Rev Urol

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“…[159–161] While awaiting results of further studies, the ISPN currently recommends that infants with VUR should receive antibiotic prophylaxis, the duration determined by the grade of reflux and occurrence of breakthrough infections. [162] The American Urological Association also recommends that antibiotic prophylaxis be given to infants with VUR grade III-V that is identified through screening.…”

Section: Postnatal Evaluation and Managementmentioning

confidence: 99%

Revised guidelines on management of antenatal hydronephrosis

Sinha

Bagga

Krishna³

et al. 2013

Indian J Nephrol

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Widespread antenatal screening has resulted in increased detection of anomalies of the kidneys and urinary tract. The present guidelines update the recommendations published in 2000. Antenatal hydronephrosis (ANH) is transient and resolves by the third trimester in almost one-half cases. The presence of oligohydramnios and additional renal or extrarenal anomalies suggests significant pathology. All patients with ANH should undergo postnatal ultrasonography; the intensity of subsequent evaluation depends on anteroposterior diameter (APD) of the renal pelvis and/or Society for Fetal Urology (SFU) grading. Patients with postnatal APD exceeding 10 mm and/or SFU grade 3-4 should be screened for upper or lower urinary tract obstruction and vesicoureteric reflux (VUR). Infants with VUR should receive antibiotic prophylaxis through the first year of life, and their parents counseled regarding the risk of urinary tract infections. The management of patients with pelviureteric junction or vesicoureteric junction obstruction depends on clinical features and results of sequential ultrasonography and radionuclide renography. Surgery is considered in patients with increasing renal pelvic APD and/or an obstructed renogram with differential renal function <35-40% or its subsequent decline. Further studies are necessary to clarify the role of prenatal intervention, frequency of follow-up investigations and indications for surgery in these patients.

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“…CAP has been the cornerstone of VUR treatment since its initial success in the mid-1970s5). However, CAP involves the risk of bacterial resistance accompanied by breakthrough UTIs and depends on patient compliance, which has been reported to be poor.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic treatment of vesicoureteral reflux in pediatric patients

Kim

2013

Korean J Pediatr

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Endoscopic treatment is a minimally invasive treatment for managing patients with vesicoureteral reflux (VUR). Although several bulking agents have been used for endoscopic treatment, dextranomer/hyaluronic acid is the only bulking agent currently approved by the U.S. Food and Drug Administration for treating VUR. Endoscopic treatment of VUR has gained great popularity owing to several obvious benefits, including short operative time, short hospital stay, minimal invasiveness, high efficacy, low complication rate, and reduced cost. Initially, the success rates of endoscopic treatment have been lower than that of open antireflux surgery. However, because injection techniques have been developed, a recent study showed higher success rates of endoscopic treatment than open surgery in the treatment of patients with intermediate- and high-grade VUR. Despite the controversy surrounding its effectiveness, endoscopic treatment is considered a valuable treatment option and viable alternative to long-term antibiotic prophylaxis.

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Prophylaxis Versus No Prophylaxis for Reflux

Cited by 5 publications

References 8 publications

Antibiotic prophylaxis in antenatal nonrefluxing hydronephrosis, megaureter and ureterocele

Antibiotic prophylaxis in antenatal nonrefluxing hydronephrosis, megaureter and ureterocele

Revised guidelines on management of antenatal hydronephrosis

Endoscopic treatment of vesicoureteral reflux in pediatric patients

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