Summary of the AUA guideline on management of primary vesicoureteral reflux in children

Craig A Peters, Steven J. Skoog, Billy S. Arant, Hillary L. Copp, Jack S. Elder, R. Guy Hudson, Antoine E. Khoury, Armando J. Lorenzo, Hans G. Pohl, Ellen Shapiro, Warren T. Snodgrass, Mireya Diaz

Research output: Contribution to journalArticle

313 Citations (Scopus)

Abstract

Purpose: The American Urological Association established the Vesicoureteral Reflux Guideline Update Committee in July 2005 to update the management of primary vesicoureteral reflux in children guideline. The Panel defined the task into 5 topics pertaining to specific vesicoureteral reflux management issues, which correspond to the management of 3 distinct index patients and the screening of 2 distinct index patients. This report summarizes the existing evidence pertaining to children with diagnosed reflux including those young or older than 1 year without evidence of bladder and bowel dysfunction and those older than 1 year with evidence of bladder and bowel dysfunction. From this evidence clinical practice guidelines were developed to manage the clinical scenarios insofar as the data permit. Materials and Methods: The Panel searched the MEDLINE® database from 1994 to 2008 for all relevant articles dealing with the 5 chosen guideline topics. The database was reviewed and each abstract segregated into a specific topic area. Exclusions were case reports, basic science, secondary reflux, review articles and not relevant. The extracted article to be accepted should have assessed a cohort of children with vesicoureteral reflux and a defined care program that permitted identification of cohort specific clinical outcomes. The reporting of meta-analysis of observational studies elaborated by the MOOSE (Meta-analysis Of Observational Studies in Epidemiology) group was followed. The extracted data were analyzed and formulated into evidence-based recommendations. Results: A total of 2,028 articles were reviewed and data were extracted from 131 articles. Data from 17,972 patients were included in this analysis. This systematic meta-analysis identified increasing frequency of urinary tract infection, increasing grade of vesicoureteral reflux and presence of bladder and bowel dysfunction as unique risk factors for renal cortical scarring. The efficacy of continuous antibiotic prophylaxis could not be established with current data. However, its purported lack of efficacy, as reported in selected prospective clinical trials, also is unproven owing to significant limitations in these studies. Reflux resolution and endoscopic surgical success rates are dependent upon bladder and bowel dysfunction. The Panel then structured guidelines for clinical vesicoureteral reflux management based on the goals of minimizing the risk of acute infection and renal injury, while minimizing the morbidity of testing and management. These guidelines are specific to children based on age as well as the presence of bladder and bowel dysfunction. Recommendations for long-term followup based on risk level are also included. Conclusions: Using a structured, formal meta-analytic technique with rigorous data selection, conditioning and quality assessment, we attempted to structure clinically relevant guidelines for managing vesicoureteral reflux in children. The lack of robust prospective randomized controlled trials limits the strength of these guidelines but they can serve to provide a framework for practice and set boundaries for safe and effective practice. As new data emerge, these guidelines will necessarily evolve.

Original languageEnglish (US)
Pages (from-to)1134-1144
Number of pages11
JournalJournal of Urology
Volume184
Issue number3
DOIs
StatePublished - Sep 1 2010

Fingerprint

Vesico-Ureteral Reflux
Guidelines
Urinary Bladder
Meta-Analysis
Observational Studies
Databases
Antibiotic Prophylaxis
Practice Guidelines
Acute Kidney Injury
Urinary Tract Infections
MEDLINE
Cicatrix
Epidemiology
Randomized Controlled Trials
Clinical Trials
Morbidity
Kidney
Infection

Keywords

  • child
  • intestines
  • ureter
  • urinary bladder
  • vesico-ureteral reflux

ASJC Scopus subject areas

  • Urology
  • Medicine(all)

Cite this

Peters, C. A., Skoog, S. J., Arant, B. S., Copp, H. L., Elder, J. S., Hudson, R. G., ... Diaz, M. (2010). Summary of the AUA guideline on management of primary vesicoureteral reflux in children. Journal of Urology, 184(3), 1134-1144. https://doi.org/10.1016/j.juro.2010.05.065

Summary of the AUA guideline on management of primary vesicoureteral reflux in children. / Peters, Craig A; Skoog, Steven J.; Arant, Billy S.; Copp, Hillary L.; Elder, Jack S.; Hudson, R. Guy; Khoury, Antoine E.; Lorenzo, Armando J.; Pohl, Hans G.; Shapiro, Ellen; Snodgrass, Warren T.; Diaz, Mireya.

In: Journal of Urology, Vol. 184, No. 3, 01.09.2010, p. 1134-1144.

Research output: Contribution to journalArticle

Peters, CA, Skoog, SJ, Arant, BS, Copp, HL, Elder, JS, Hudson, RG, Khoury, AE, Lorenzo, AJ, Pohl, HG, Shapiro, E, Snodgrass, WT & Diaz, M 2010, 'Summary of the AUA guideline on management of primary vesicoureteral reflux in children', Journal of Urology, vol. 184, no. 3, pp. 1134-1144. https://doi.org/10.1016/j.juro.2010.05.065
Peters, Craig A ; Skoog, Steven J. ; Arant, Billy S. ; Copp, Hillary L. ; Elder, Jack S. ; Hudson, R. Guy ; Khoury, Antoine E. ; Lorenzo, Armando J. ; Pohl, Hans G. ; Shapiro, Ellen ; Snodgrass, Warren T. ; Diaz, Mireya. / Summary of the AUA guideline on management of primary vesicoureteral reflux in children. In: Journal of Urology. 2010 ; Vol. 184, No. 3. pp. 1134-1144.
@article{d5e46fa42f454193b028bc4ce03b8f50,
title = "Summary of the AUA guideline on management of primary vesicoureteral reflux in children",
abstract = "Purpose: The American Urological Association established the Vesicoureteral Reflux Guideline Update Committee in July 2005 to update the management of primary vesicoureteral reflux in children guideline. The Panel defined the task into 5 topics pertaining to specific vesicoureteral reflux management issues, which correspond to the management of 3 distinct index patients and the screening of 2 distinct index patients. This report summarizes the existing evidence pertaining to children with diagnosed reflux including those young or older than 1 year without evidence of bladder and bowel dysfunction and those older than 1 year with evidence of bladder and bowel dysfunction. From this evidence clinical practice guidelines were developed to manage the clinical scenarios insofar as the data permit. Materials and Methods: The Panel searched the MEDLINE{\circledR} database from 1994 to 2008 for all relevant articles dealing with the 5 chosen guideline topics. The database was reviewed and each abstract segregated into a specific topic area. Exclusions were case reports, basic science, secondary reflux, review articles and not relevant. The extracted article to be accepted should have assessed a cohort of children with vesicoureteral reflux and a defined care program that permitted identification of cohort specific clinical outcomes. The reporting of meta-analysis of observational studies elaborated by the MOOSE (Meta-analysis Of Observational Studies in Epidemiology) group was followed. The extracted data were analyzed and formulated into evidence-based recommendations. Results: A total of 2,028 articles were reviewed and data were extracted from 131 articles. Data from 17,972 patients were included in this analysis. This systematic meta-analysis identified increasing frequency of urinary tract infection, increasing grade of vesicoureteral reflux and presence of bladder and bowel dysfunction as unique risk factors for renal cortical scarring. The efficacy of continuous antibiotic prophylaxis could not be established with current data. However, its purported lack of efficacy, as reported in selected prospective clinical trials, also is unproven owing to significant limitations in these studies. Reflux resolution and endoscopic surgical success rates are dependent upon bladder and bowel dysfunction. The Panel then structured guidelines for clinical vesicoureteral reflux management based on the goals of minimizing the risk of acute infection and renal injury, while minimizing the morbidity of testing and management. These guidelines are specific to children based on age as well as the presence of bladder and bowel dysfunction. Recommendations for long-term followup based on risk level are also included. Conclusions: Using a structured, formal meta-analytic technique with rigorous data selection, conditioning and quality assessment, we attempted to structure clinically relevant guidelines for managing vesicoureteral reflux in children. The lack of robust prospective randomized controlled trials limits the strength of these guidelines but they can serve to provide a framework for practice and set boundaries for safe and effective practice. As new data emerge, these guidelines will necessarily evolve.",
keywords = "child, intestines, ureter, urinary bladder, vesico-ureteral reflux",
author = "Peters, {Craig A} and Skoog, {Steven J.} and Arant, {Billy S.} and Copp, {Hillary L.} and Elder, {Jack S.} and Hudson, {R. Guy} and Khoury, {Antoine E.} and Lorenzo, {Armando J.} and Pohl, {Hans G.} and Ellen Shapiro and Snodgrass, {Warren T.} and Mireya Diaz",
year = "2010",
month = "9",
day = "1",
doi = "10.1016/j.juro.2010.05.065",
language = "English (US)",
volume = "184",
pages = "1134--1144",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - Summary of the AUA guideline on management of primary vesicoureteral reflux in children

AU - Peters, Craig A

AU - Skoog, Steven J.

AU - Arant, Billy S.

AU - Copp, Hillary L.

AU - Elder, Jack S.

AU - Hudson, R. Guy

AU - Khoury, Antoine E.

AU - Lorenzo, Armando J.

AU - Pohl, Hans G.

AU - Shapiro, Ellen

AU - Snodgrass, Warren T.

AU - Diaz, Mireya

PY - 2010/9/1

Y1 - 2010/9/1

N2 - Purpose: The American Urological Association established the Vesicoureteral Reflux Guideline Update Committee in July 2005 to update the management of primary vesicoureteral reflux in children guideline. The Panel defined the task into 5 topics pertaining to specific vesicoureteral reflux management issues, which correspond to the management of 3 distinct index patients and the screening of 2 distinct index patients. This report summarizes the existing evidence pertaining to children with diagnosed reflux including those young or older than 1 year without evidence of bladder and bowel dysfunction and those older than 1 year with evidence of bladder and bowel dysfunction. From this evidence clinical practice guidelines were developed to manage the clinical scenarios insofar as the data permit. Materials and Methods: The Panel searched the MEDLINE® database from 1994 to 2008 for all relevant articles dealing with the 5 chosen guideline topics. The database was reviewed and each abstract segregated into a specific topic area. Exclusions were case reports, basic science, secondary reflux, review articles and not relevant. The extracted article to be accepted should have assessed a cohort of children with vesicoureteral reflux and a defined care program that permitted identification of cohort specific clinical outcomes. The reporting of meta-analysis of observational studies elaborated by the MOOSE (Meta-analysis Of Observational Studies in Epidemiology) group was followed. The extracted data were analyzed and formulated into evidence-based recommendations. Results: A total of 2,028 articles were reviewed and data were extracted from 131 articles. Data from 17,972 patients were included in this analysis. This systematic meta-analysis identified increasing frequency of urinary tract infection, increasing grade of vesicoureteral reflux and presence of bladder and bowel dysfunction as unique risk factors for renal cortical scarring. The efficacy of continuous antibiotic prophylaxis could not be established with current data. However, its purported lack of efficacy, as reported in selected prospective clinical trials, also is unproven owing to significant limitations in these studies. Reflux resolution and endoscopic surgical success rates are dependent upon bladder and bowel dysfunction. The Panel then structured guidelines for clinical vesicoureteral reflux management based on the goals of minimizing the risk of acute infection and renal injury, while minimizing the morbidity of testing and management. These guidelines are specific to children based on age as well as the presence of bladder and bowel dysfunction. Recommendations for long-term followup based on risk level are also included. Conclusions: Using a structured, formal meta-analytic technique with rigorous data selection, conditioning and quality assessment, we attempted to structure clinically relevant guidelines for managing vesicoureteral reflux in children. The lack of robust prospective randomized controlled trials limits the strength of these guidelines but they can serve to provide a framework for practice and set boundaries for safe and effective practice. As new data emerge, these guidelines will necessarily evolve.

AB - Purpose: The American Urological Association established the Vesicoureteral Reflux Guideline Update Committee in July 2005 to update the management of primary vesicoureteral reflux in children guideline. The Panel defined the task into 5 topics pertaining to specific vesicoureteral reflux management issues, which correspond to the management of 3 distinct index patients and the screening of 2 distinct index patients. This report summarizes the existing evidence pertaining to children with diagnosed reflux including those young or older than 1 year without evidence of bladder and bowel dysfunction and those older than 1 year with evidence of bladder and bowel dysfunction. From this evidence clinical practice guidelines were developed to manage the clinical scenarios insofar as the data permit. Materials and Methods: The Panel searched the MEDLINE® database from 1994 to 2008 for all relevant articles dealing with the 5 chosen guideline topics. The database was reviewed and each abstract segregated into a specific topic area. Exclusions were case reports, basic science, secondary reflux, review articles and not relevant. The extracted article to be accepted should have assessed a cohort of children with vesicoureteral reflux and a defined care program that permitted identification of cohort specific clinical outcomes. The reporting of meta-analysis of observational studies elaborated by the MOOSE (Meta-analysis Of Observational Studies in Epidemiology) group was followed. The extracted data were analyzed and formulated into evidence-based recommendations. Results: A total of 2,028 articles were reviewed and data were extracted from 131 articles. Data from 17,972 patients were included in this analysis. This systematic meta-analysis identified increasing frequency of urinary tract infection, increasing grade of vesicoureteral reflux and presence of bladder and bowel dysfunction as unique risk factors for renal cortical scarring. The efficacy of continuous antibiotic prophylaxis could not be established with current data. However, its purported lack of efficacy, as reported in selected prospective clinical trials, also is unproven owing to significant limitations in these studies. Reflux resolution and endoscopic surgical success rates are dependent upon bladder and bowel dysfunction. The Panel then structured guidelines for clinical vesicoureteral reflux management based on the goals of minimizing the risk of acute infection and renal injury, while minimizing the morbidity of testing and management. These guidelines are specific to children based on age as well as the presence of bladder and bowel dysfunction. Recommendations for long-term followup based on risk level are also included. Conclusions: Using a structured, formal meta-analytic technique with rigorous data selection, conditioning and quality assessment, we attempted to structure clinically relevant guidelines for managing vesicoureteral reflux in children. The lack of robust prospective randomized controlled trials limits the strength of these guidelines but they can serve to provide a framework for practice and set boundaries for safe and effective practice. As new data emerge, these guidelines will necessarily evolve.

KW - child

KW - intestines

KW - ureter

KW - urinary bladder

KW - vesico-ureteral reflux

UR - http://www.scopus.com/inward/record.url?scp=77956631925&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77956631925&partnerID=8YFLogxK

U2 - 10.1016/j.juro.2010.05.065

DO - 10.1016/j.juro.2010.05.065

M3 - Article

C2 - 20650499

AN - SCOPUS:77956631925

VL - 184

SP - 1134

EP - 1144

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 3

ER -