Delayed Upper Tract Drainage on Voiding Cystourethrogram May Not Be Associated With Increased Risk of Urinary Tract Infection in Children With Vesicoureteral Reflux
Summary Introduction Urinary stasis in the setting of obstruction provides an opportunistic environment for bacterial multiplication and is a well-established risk factor for UTI. Vesicoureteral reflux (VUR) with delayed upper tract drainage (UTD) on VCUG has been reported to correlate with increase...
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| creator | Garcia-Roig, Michael Arlen, Angela M Huang, Jonathan H Filimon, Eleonora Leong, Traci Kirsch, Andrew J., MD |
| description | Summary Introduction Urinary stasis in the setting of obstruction provides an opportunistic environment for bacterial multiplication and is a well-established risk factor for UTI. Vesicoureteral reflux (VUR) with delayed upper tract drainage (UTD) on VCUG has been reported to correlate with increased UTI risk. We sought to determine whether delayed UTD can be reliably classified, and whether it correlates with UTI incidence, VCUG, or endoscopic findings. Methods Children undergoing endoscopic surgery for primary VUR (2009–2012) were identified. VUR grade, timing, and laterality were abstracted. Demographics, hydrodistention (HD) grade, reported febrile and culture-proven UTI were assessed. UTD on VCUG was graded on post-void images as 1 = partial/complete UTD or 2 = no/increased UTD. Inter-observer agreement was calculated. Patients were excluded for incomplete imaging or inability to void during VCUG. Results The cohort included 128 patients (10M, 118F), mean age 4.1±2.1 years. Mean age at diagnosis was 2.8±2.8 years. Mean maximum VUR grade was 3±0.9: 1 (7.8%), 2 (20.3%), 3 (43%), 4 (25.8%), 5 (3.1). UTD occurred in 45 (35%), and no drainage in 83 (65%) patients. Agreement coefficient between graders was 0.596 ( p |
| doi_str_mv | 10.1016/j.jpurol.2016.04.056 |
| format | Article |
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Vesicoureteral reflux (VUR) with delayed upper tract drainage (UTD) on VCUG has been reported to correlate with increased UTI risk. We sought to determine whether delayed UTD can be reliably classified, and whether it correlates with UTI incidence, VCUG, or endoscopic findings. Methods Children undergoing endoscopic surgery for primary VUR (2009–2012) were identified. VUR grade, timing, and laterality were abstracted. Demographics, hydrodistention (HD) grade, reported febrile and culture-proven UTI were assessed. UTD on VCUG was graded on post-void images as 1 = partial/complete UTD or 2 = no/increased UTD. Inter-observer agreement was calculated. Patients were excluded for incomplete imaging or inability to void during VCUG. Results The cohort included 128 patients (10M, 118F), mean age 4.1±2.1 years. Mean age at diagnosis was 2.8±2.8 years. Mean maximum VUR grade was 3±0.9: 1 (7.8%), 2 (20.3%), 3 (43%), 4 (25.8%), 5 (3.1). UTD occurred in 45 (35%), and no drainage in 83 (65%) patients. Agreement coefficient between graders was 0.596 ( p <0.0001). Cultures were available in 100 patients (70 positive). Patients experienced a mean of 2±1.2 parent-reported fUTIs and 1.2±1.2 culture-proven UTIs from birth to surgery. UTI rate did not differ by UTD status for parent or culture-proven UTI (Table). On multivariate analysis, no patient characteristic was a significant predictor of UTI based on drainage status. Children diagnosed with VUR before 1 year of age had a higher verified UTI rate ( p <0.001). However, drainage was not a significant predictor of UTI rate and when testing the interaction of drainage and age. Conclusion We sought to determine whether UTD was an accurate predictor of UTI risk to maximize available prognostic information from a single VCUG. Delayed UTD was not a predictor of infection in our patients, nor was it associated with previously described UTI risk factors, such as VUR timing or grade, and voiding dysfunction. Limitations included the retrospective nature of the study in patients undergoing endoscopic VUR treatment, and possible inaccurate UTI reports from parents and pediatricians. UTD can be reliably scored using a binary system with high inter-observer correlation. Our data call into question the previous finding that children with poor UTD are at increased risk of recurrent UTI. Delayed UTD is also not associated with higher HD, or VUR grade compared with those with more prompt UTD.</description><identifier>ISSN: 1477-5131</identifier><identifier>EISSN: 1873-4898</identifier><identifier>DOI: 10.1016/j.jpurol.2016.04.056</identifier><identifier>PMID: 27492248</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Child, Preschool ; Cystography ; Female ; Humans ; Hydronephrosis ; Infant ; Male ; Pediatrics ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Ureter - diagnostic imaging ; Ureteroscopy ; Urinary tract infection ; Urinary Tract Infections - epidemiology ; Urinary Tract Infections - etiology ; Urinary Tract Infections - physiopathology ; Urination ; Urography ; Urology ; Vesico-Ureteral Reflux - complications ; Vesico-Ureteral Reflux - diagnostic imaging ; Vesico-Ureteral Reflux - physiopathology ; Vesicoureteral reflux ; Voiding cystourethrogram</subject><ispartof>Journal of pediatric urology, 2016-10, Vol.12 (5), p.312.e1-312.e6</ispartof><rights>2016 Journal of Pediatric Urology Company</rights><rights>Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c417t-2265a12159fe737f5d683674a29ee5b46d2cfe48552ecf549b85cad8c0e712173</citedby><cites>FETCH-LOGICAL-c417t-2265a12159fe737f5d683674a29ee5b46d2cfe48552ecf549b85cad8c0e712173</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jpurol.2016.04.056$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27492248$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Garcia-Roig, Michael</creatorcontrib><creatorcontrib>Arlen, Angela M</creatorcontrib><creatorcontrib>Huang, Jonathan H</creatorcontrib><creatorcontrib>Filimon, Eleonora</creatorcontrib><creatorcontrib>Leong, Traci</creatorcontrib><creatorcontrib>Kirsch, Andrew J., MD</creatorcontrib><title>Delayed Upper Tract Drainage on Voiding Cystourethrogram May Not Be Associated With Increased Risk of Urinary Tract Infection in Children With Vesicoureteral Reflux</title><title>Journal of pediatric urology</title><addtitle>J Pediatr Urol</addtitle><description>Summary Introduction Urinary stasis in the setting of obstruction provides an opportunistic environment for bacterial multiplication and is a well-established risk factor for UTI. Vesicoureteral reflux (VUR) with delayed upper tract drainage (UTD) on VCUG has been reported to correlate with increased UTI risk. We sought to determine whether delayed UTD can be reliably classified, and whether it correlates with UTI incidence, VCUG, or endoscopic findings. Methods Children undergoing endoscopic surgery for primary VUR (2009–2012) were identified. VUR grade, timing, and laterality were abstracted. Demographics, hydrodistention (HD) grade, reported febrile and culture-proven UTI were assessed. UTD on VCUG was graded on post-void images as 1 = partial/complete UTD or 2 = no/increased UTD. Inter-observer agreement was calculated. Patients were excluded for incomplete imaging or inability to void during VCUG. Results The cohort included 128 patients (10M, 118F), mean age 4.1±2.1 years. Mean age at diagnosis was 2.8±2.8 years. Mean maximum VUR grade was 3±0.9: 1 (7.8%), 2 (20.3%), 3 (43%), 4 (25.8%), 5 (3.1). UTD occurred in 45 (35%), and no drainage in 83 (65%) patients. Agreement coefficient between graders was 0.596 ( p <0.0001). Cultures were available in 100 patients (70 positive). Patients experienced a mean of 2±1.2 parent-reported fUTIs and 1.2±1.2 culture-proven UTIs from birth to surgery. UTI rate did not differ by UTD status for parent or culture-proven UTI (Table). On multivariate analysis, no patient characteristic was a significant predictor of UTI based on drainage status. Children diagnosed with VUR before 1 year of age had a higher verified UTI rate ( p <0.001). However, drainage was not a significant predictor of UTI rate and when testing the interaction of drainage and age. Conclusion We sought to determine whether UTD was an accurate predictor of UTI risk to maximize available prognostic information from a single VCUG. Delayed UTD was not a predictor of infection in our patients, nor was it associated with previously described UTI risk factors, such as VUR timing or grade, and voiding dysfunction. Limitations included the retrospective nature of the study in patients undergoing endoscopic VUR treatment, and possible inaccurate UTI reports from parents and pediatricians. UTD can be reliably scored using a binary system with high inter-observer correlation. Our data call into question the previous finding that children with poor UTD are at increased risk of recurrent UTI. Delayed UTD is also not associated with higher HD, or VUR grade compared with those with more prompt UTD.</description><subject>Child, Preschool</subject><subject>Cystography</subject><subject>Female</subject><subject>Humans</subject><subject>Hydronephrosis</subject><subject>Infant</subject><subject>Male</subject><subject>Pediatrics</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Ureter - diagnostic imaging</subject><subject>Ureteroscopy</subject><subject>Urinary tract infection</subject><subject>Urinary Tract Infections - epidemiology</subject><subject>Urinary Tract Infections - etiology</subject><subject>Urinary Tract Infections - physiopathology</subject><subject>Urination</subject><subject>Urography</subject><subject>Urology</subject><subject>Vesico-Ureteral Reflux - complications</subject><subject>Vesico-Ureteral Reflux - diagnostic imaging</subject><subject>Vesico-Ureteral Reflux - physiopathology</subject><subject>Vesicoureteral reflux</subject><subject>Voiding cystourethrogram</subject><issn>1477-5131</issn><issn>1873-4898</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUstu1DAUjRCIlsIfIOQlmwTbseNkg1SmPEYqIJVOWVoe52bGqccOdoLI__CheMjAgg0r-0rnoXvOzbLnBBcEk-pVX_TDFLwtaJoKzArMqwfZOalFmbO6qR-mPxMi56QkZ9mTGHuMS4Fp8zg7o4I1lLL6PPt5BVbN0KLNMEBAt0HpEV0FZZzaAfIO3XnTGrdDqzmOfgow7oPfBXVAH9WMPvkRvQF0GaPXRo1J5qsZ92jtdAAV03hj4j3yHdqEJBjmk_7adaBHk9SNQ6u9sW0At1DvIBr92weCsugGOjv9eJo96pSN8Oz0XmSbd29vVx_y68_v16vL61wzIsac0oorQglvOhCl6Hhb1WUlmKINAN-yqqW6A1ZzTkF3nDXbmmvV1hqDSDRRXmQvF90h-G8TxFEeTNRgrXLgpyhJzZMFY5glKFugOvgYA3RyCOaQVpQEy2M_spdLP_LYj8RMpn4S7cXJYdoeoP1L-lNIArxeAJD2_G4gyKgNOA2tCSkz2XrzP4d_BbQ1zmhl72GG2KdsXcpQEhmpxPLL8UaOJ0KqEqfb4eUvu5C6dQ</recordid><startdate>20161001</startdate><enddate>20161001</enddate><creator>Garcia-Roig, Michael</creator><creator>Arlen, Angela M</creator><creator>Huang, Jonathan H</creator><creator>Filimon, Eleonora</creator><creator>Leong, Traci</creator><creator>Kirsch, Andrew J., MD</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20161001</creationdate><title>Delayed Upper Tract Drainage on Voiding Cystourethrogram May Not Be Associated With Increased Risk of Urinary Tract Infection in Children With Vesicoureteral Reflux</title><author>Garcia-Roig, Michael ; Arlen, Angela M ; Huang, Jonathan H ; Filimon, Eleonora ; Leong, Traci ; Kirsch, Andrew J., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c417t-2265a12159fe737f5d683674a29ee5b46d2cfe48552ecf549b85cad8c0e712173</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Child, Preschool</topic><topic>Cystography</topic><topic>Female</topic><topic>Humans</topic><topic>Hydronephrosis</topic><topic>Infant</topic><topic>Male</topic><topic>Pediatrics</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Ureter - diagnostic imaging</topic><topic>Ureteroscopy</topic><topic>Urinary tract infection</topic><topic>Urinary Tract Infections - epidemiology</topic><topic>Urinary Tract Infections - etiology</topic><topic>Urinary Tract Infections - physiopathology</topic><topic>Urination</topic><topic>Urography</topic><topic>Urology</topic><topic>Vesico-Ureteral Reflux - complications</topic><topic>Vesico-Ureteral Reflux - diagnostic imaging</topic><topic>Vesico-Ureteral Reflux - physiopathology</topic><topic>Vesicoureteral reflux</topic><topic>Voiding cystourethrogram</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Garcia-Roig, Michael</creatorcontrib><creatorcontrib>Arlen, Angela M</creatorcontrib><creatorcontrib>Huang, Jonathan H</creatorcontrib><creatorcontrib>Filimon, Eleonora</creatorcontrib><creatorcontrib>Leong, Traci</creatorcontrib><creatorcontrib>Kirsch, Andrew J., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of pediatric urology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Garcia-Roig, Michael</au><au>Arlen, Angela M</au><au>Huang, Jonathan H</au><au>Filimon, Eleonora</au><au>Leong, Traci</au><au>Kirsch, Andrew J., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Delayed Upper Tract Drainage on Voiding Cystourethrogram May Not Be Associated With Increased Risk of Urinary Tract Infection in Children With Vesicoureteral Reflux</atitle><jtitle>Journal of pediatric urology</jtitle><addtitle>J Pediatr Urol</addtitle><date>2016-10-01</date><risdate>2016</risdate><volume>12</volume><issue>5</issue><spage>312.e1</spage><epage>312.e6</epage><pages>312.e1-312.e6</pages><issn>1477-5131</issn><eissn>1873-4898</eissn><abstract>Summary Introduction Urinary stasis in the setting of obstruction provides an opportunistic environment for bacterial multiplication and is a well-established risk factor for UTI. Vesicoureteral reflux (VUR) with delayed upper tract drainage (UTD) on VCUG has been reported to correlate with increased UTI risk. We sought to determine whether delayed UTD can be reliably classified, and whether it correlates with UTI incidence, VCUG, or endoscopic findings. Methods Children undergoing endoscopic surgery for primary VUR (2009–2012) were identified. VUR grade, timing, and laterality were abstracted. Demographics, hydrodistention (HD) grade, reported febrile and culture-proven UTI were assessed. UTD on VCUG was graded on post-void images as 1 = partial/complete UTD or 2 = no/increased UTD. Inter-observer agreement was calculated. Patients were excluded for incomplete imaging or inability to void during VCUG. Results The cohort included 128 patients (10M, 118F), mean age 4.1±2.1 years. Mean age at diagnosis was 2.8±2.8 years. Mean maximum VUR grade was 3±0.9: 1 (7.8%), 2 (20.3%), 3 (43%), 4 (25.8%), 5 (3.1). UTD occurred in 45 (35%), and no drainage in 83 (65%) patients. Agreement coefficient between graders was 0.596 ( p <0.0001). Cultures were available in 100 patients (70 positive). Patients experienced a mean of 2±1.2 parent-reported fUTIs and 1.2±1.2 culture-proven UTIs from birth to surgery. UTI rate did not differ by UTD status for parent or culture-proven UTI (Table). On multivariate analysis, no patient characteristic was a significant predictor of UTI based on drainage status. Children diagnosed with VUR before 1 year of age had a higher verified UTI rate ( p <0.001). However, drainage was not a significant predictor of UTI rate and when testing the interaction of drainage and age. Conclusion We sought to determine whether UTD was an accurate predictor of UTI risk to maximize available prognostic information from a single VCUG. Delayed UTD was not a predictor of infection in our patients, nor was it associated with previously described UTI risk factors, such as VUR timing or grade, and voiding dysfunction. Limitations included the retrospective nature of the study in patients undergoing endoscopic VUR treatment, and possible inaccurate UTI reports from parents and pediatricians. UTD can be reliably scored using a binary system with high inter-observer correlation. Our data call into question the previous finding that children with poor UTD are at increased risk of recurrent UTI. Delayed UTD is also not associated with higher HD, or VUR grade compared with those with more prompt UTD.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>27492248</pmid><doi>10.1016/j.jpurol.2016.04.056</doi></addata></record> |
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| subjects | Child, Preschool Cystography Female Humans Hydronephrosis Infant Male Pediatrics Retrospective Studies Risk Assessment Risk Factors Time Factors Ureter - diagnostic imaging Ureteroscopy Urinary tract infection Urinary Tract Infections - epidemiology Urinary Tract Infections - etiology Urinary Tract Infections - physiopathology Urination Urography Urology Vesico-Ureteral Reflux - complications Vesico-Ureteral Reflux - diagnostic imaging Vesico-Ureteral Reflux - physiopathology Vesicoureteral reflux Voiding cystourethrogram |
| title | Delayed Upper Tract Drainage on Voiding Cystourethrogram May Not Be Associated With Increased Risk of Urinary Tract Infection in Children With Vesicoureteral Reflux |
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