Vesicoureteral reflux

Question 1

What is recommended in the evaluation of VUR?

Answer 1

Hight
Weight
Blood pressure
Cr 
UA
RUS

Question 2

What is an option for evaluating VUR?

Answer 2

DMSA scan

Question 3

What is the effect of BBD on VUR?

Answer 3

Can decrease the success rate of CAP from 61% to 31%. Endoscopic surgery from 89% to 50%. But does not influence surgical resolution rates (97%).

Question 4

What questions should be asked during VUR evaluation?

Answer 4

frequency/urgency
Voiding intervals
incontinence
Perineal pain
Holding maneuvers

Question 5

What are the 3 goals of VUR treatment?

Answer 5

1. prevent UTIs
2. Prevent renal injury
3. minimize tx morbidity

Question 6

Tx for child < 1 year old with febrile UTI and VUR?

Answer 6

CAP

Question 7

Tx for child < 1 year old with VUR but no febrile UTIs?

Answer 7

CAP if VUR III-V

CAP not necessary for VUR I-II

Question 8

What other treatment can be offered to males with VUR?

Answer 8

Circumcision to reduce the risk of UTI.

Question 9

Child > 1 year old with VUR and BBD. What is the first line tx?

Answer 9

Treat BBD

Give CAP while tx BBD.

Question 10

Child > 1 year old with VUR and no BBD. First line tx?

Answer 10

Observation

Abx only for UTIs

Question 11

How should children with VUR be followed up?

Answer 11

BP, height, weight, UA, RUS, annually. VCUG every 2 years.

Question 12

Abnormal RUS in the context of VUR. What is the next step?

Answer 12

Obtain DMSA scan.

Question 13

What is the resolution rate for open surgery for VUR?

Answer 13

98.1%

Question 14

What is the resolution rate for endoscopic management of VUR?

Answer 14

83%

Question 15

What is the rate of post operative urinary obstruction following surgical management of VUR?

Answer 15

0.4%

Question 16

What should be obtained at follow up for surgical management of VUR?

Answer 16

RUS

VCUG

Question 17

How should VUR be followed after resolution?

Answer 17

Height, Weight, BP, UA annually. If either kidney is abnormal then obtain yearly RUS or DMSA scans.

Question 18

What is the rate of VUR in siblings of a VUR patient?

Answer 18

27%, Screen with VCUG if siblings have history of UTI.

Question 19

What is the incidence of VUR in patients with prenatal hydronephrosis?

Answer 19

16%

Question 20

Child with Grade III-IV hydronephrosis, hydroureter, and abnormal bladder, may have developed UTI. Next step?

Answer 20

VCUG

Question 21

Grade I-II prenatal hydronephrosis?

Answer 21

Observation

Question 22

Breakthrough febrile UTI with VUR. Next step?

Answer 22

Endoscopic bulking injections or open surgery are recommended. Alternative antibiotic is an option.