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Re: The Prognostic Impact of an Abnormal Initial Renal Ultrasound on Early Reflux Resolution
Urological Survey
Pediatric Urology Re: The Prognostic Impact of an Abnormal Initial Renal Ultrasound on Early Reflux Resolution K. G. Nepple, A. M. Arlen, J. C. Austin and C. S. Cooper Division of Pediatric Urology, University of Iowa, Iowa City, Iowa J Pediatr Urol 2011; 7: 462– 466.
Objective: In a group of children diagnosed with vesicoureteral reflux (VUR) we evaluated renal ultrasound findings, associated findings on renal scan, and prognostic impact on VUR resolution. Methods: Medical records were reviewed for children with primary reflux and no history of antenatal hydronephrosis who underwent an initial renal ultrasound. Abnormal renal ultrasound was defined as hydronephrosis or relative difference in renal size ⱖ1 cm. Reflux resolution was evaluated at 2 years post diagnosis. Results: In 129 children with VUR (111 girls, 18 boys), 39 (30%) had an abnormal renal ultrasound. Two-year VUR resolution in the abnormal renal ultrasound group was 21% versus 46% in the group with normal renal ultrasound (P ⫽ 0.01). Combining grade II and III reflux, an abnormal ultrasound was associated with a statistically significantly lower resolution rate (grade II–III 23% vs 47%, P ⫽ 0.049). For children with moderate hydronephrosis, 8/9 (89%) had abnormal initial renal scans and all failed to achieve resolution of reflux at 2 years. Conclusions: In this cohort of children with VUR, 30% had abnormalities on renal ultrasound. The presence of moderate hydronephrosis on ultrasound may indicate a high likelihood of abnormality on renal scan and failure to achieve early resolution of VUR. Editorial Comment: Although we know that abnormal ultrasound is not a good predictor of the presence of VUR, this study suggests that in the context of known pediatric VUR a smaller kidney or a kidney with hydronephrosis is associated with a decreased reflux resolution rate. These authors have helped to lead the way with a number of parameters to determine those at greatest risk for vesicoureteral reflux. In an effort to simplify their previous renal scan based algorithm they have reported their retrospective series with ultrasound alone. Any indicator that helps to separate cases of VUR less likely to resolve, which require close and prolonged monitoring, from those that will likely resolve is useful as long as we use the data to help assay prognosis as the authors intend, rather than to guide a decision for or against surgery. Douglas A. Canning, M.D.
Re: Clinical and Radiographic Results of Endoscopic Injection for Vesicoureteral Reflux: Defining Measures of Success J. D. Kaye, A. K. Srinivasan, C. Delaney, W. H. Cerwinka, J. M. Elmore, H. C. Scherz and A. J. Kirsch Department of Pediatric Urology, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia J Pediatr Urol 2012; 8: 297–303.
Objective: Criteria for success following endoscopic vesicoureteral reflux (VUR) surgery vary greatly. We sought to define outcomes based on radiographic and long-term clinical follow up. Methods: We reviewed the charts and interviewed parents of children who underwent endoscopic treatment for 0022-5347/13/1892-0694/0 THE JOURNAL OF UROLOGY® © 2013 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
694
www.jurology.com
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2012.10.078 Vol. 189, 694-696, February 2013 Printed in U.S.A.
Pediatric Urology Re: The Prognostic Impact of an Abnormal Initial Renal Ultrasound on Early Reflux Resolution K. G. Nepple, A. M. Arlen, J. C. Austin and C. S. Cooper Division of Pediatric Urology, University of Iowa, Iowa City, Iowa J Pediatr Urol 2011; 7: 462– 466.
Objective: In a group of children diagnosed with vesicoureteral reflux (VUR) we evaluated renal ultrasound findings, associated findings on renal scan, and prognostic impact on VUR resolution. Methods: Medical records were reviewed for children with primary reflux and no history of antenatal hydronephrosis who underwent an initial renal ultrasound. Abnormal renal ultrasound was defined as hydronephrosis or relative difference in renal size ⱖ1 cm. Reflux resolution was evaluated at 2 years post diagnosis. Results: In 129 children with VUR (111 girls, 18 boys), 39 (30%) had an abnormal renal ultrasound. Two-year VUR resolution in the abnormal renal ultrasound group was 21% versus 46% in the group with normal renal ultrasound (P ⫽ 0.01). Combining grade II and III reflux, an abnormal ultrasound was associated with a statistically significantly lower resolution rate (grade II–III 23% vs 47%, P ⫽ 0.049). For children with moderate hydronephrosis, 8/9 (89%) had abnormal initial renal scans and all failed to achieve resolution of reflux at 2 years. Conclusions: In this cohort of children with VUR, 30% had abnormalities on renal ultrasound. The presence of moderate hydronephrosis on ultrasound may indicate a high likelihood of abnormality on renal scan and failure to achieve early resolution of VUR. Editorial Comment: Although we know that abnormal ultrasound is not a good predictor of the presence of VUR, this study suggests that in the context of known pediatric VUR a smaller kidney or a kidney with hydronephrosis is associated with a decreased reflux resolution rate. These authors have helped to lead the way with a number of parameters to determine those at greatest risk for vesicoureteral reflux. In an effort to simplify their previous renal scan based algorithm they have reported their retrospective series with ultrasound alone. Any indicator that helps to separate cases of VUR less likely to resolve, which require close and prolonged monitoring, from those that will likely resolve is useful as long as we use the data to help assay prognosis as the authors intend, rather than to guide a decision for or against surgery. Douglas A. Canning, M.D.
Re: Clinical and Radiographic Results of Endoscopic Injection for Vesicoureteral Reflux: Defining Measures of Success J. D. Kaye, A. K. Srinivasan, C. Delaney, W. H. Cerwinka, J. M. Elmore, H. C. Scherz and A. J. Kirsch Department of Pediatric Urology, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia J Pediatr Urol 2012; 8: 297–303.
Objective: Criteria for success following endoscopic vesicoureteral reflux (VUR) surgery vary greatly. We sought to define outcomes based on radiographic and long-term clinical follow up. Methods: We reviewed the charts and interviewed parents of children who underwent endoscopic treatment for 0022-5347/13/1892-0694/0 THE JOURNAL OF UROLOGY® © 2013 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
694
www.jurology.com
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2012.10.078 Vol. 189, 694-696, February 2013 Printed in U.S.A.