Abstract Book - 26th ESPU Congress, Joint Meeting with ICCS + SPU + AAP/SOU + AAPU + SFU

81 / 492

08:36 - 08:39
S4-5 (PP)
SCARRING ON INITIAL DMSA IS THE MOST SENSITIVE PREDICTOR OF BREAK-
THROUGH FEBRILE UTI AND PROGRESSION TO SURGERY IN A PROSPECTIVE
COHORT OF CHILDREN WITH VUR
Katherine BURNAND1, Alexander MACDONALD1, Katie WESSLEY2, Diane DE CALUWE 1, Nisha RAHMAN1 and Marie-Klaire
FARRUGIA1
1) Chelsea and Westminster Hospital, Paediatric Surgery, London, UNITED KINGDOM - 2) Chelsea and Westminster
Hospital, Paediatric Radiology, London, UNITED KINGDOM
PURPOSE
The RIVUR trial and revised AAP guidelines have shed conflicting light on the effectiveness of antibiotic prophylaxis in
VUR. Recent evidence suggests lower rates of spontaneous VUR resolution. The aim of our study was to identify the
most sensitive predictor of break-through febrile infection and hence surgical intervention in a prospective cohort of
children with VUR.
MATERIAL AND METHODS
Prospective study of consecutive patients with high-grade primary VUR who underwent MCUG and DMSA between 2011
and 2014. All patients were initially managed conservatively on antibiotic prophylaxis. Break-through febrile infection
was the main indication for surgical intervention. Data was tested with Mann-Whitney test, unpaired t test and Fisher's
exact test as appropriate. A p-value of <0.05 was considered statistically significant.
RESULTS
34 patients (24 male) met our inclusion criteria. There were 43 refluxing units (RU). Median follow-up was 28 (6-43)
months. 17 had breakthrough UTIs and underwent surgical intervention (21 RU). 21 kidneys had uptake defects on
DMSA consistent with renal scars and 15 kidneys had a differential function <40%. Refluxing kidneys that progressed to
surgery had significantly more uptake defects (16 vs 5; p = 0.0007), but a split function <40% was not significant (9 vs
6; p=0.34). VUR grade (4.14 vs 3.68; p = 0.078), age, gender, laterality, prenatal hydronephrosis, age at diagnosis,
presence of duplex or para-ureteric diverticula and timing of reflux (filling vs voiding) on MCUG were not significantly
different between surgical and conservatively managed patients.
CONCLUSIONS
Scarring on DMSA is the most sensitive predictor of break-through UTI and progression to surgery in a prospective
cohort of VUR patients.