Controversies in the management of vesicoureteral reflux: The rationale for the RIVUR study

Ranjiv Mathews, Myra Carpenter, Russell Chesney, Alejandro Hoberman, Ron Keren, Tej Mattoo, Marva Moxey-Mims, Lee Nyberg, Saul Greenfield

Research output: Contribution to journalArticlepeer-review

Abstract

The current management of vesicoureteral reflux (VUR) focuses on the prevention of urinary tract infections (UTI), with curative surgery being limited to those children that fail conservative measures. This is based on the assumption that UTIs are preventable with the use of prophylatic antibiotics, leading to reduction of renal scarring, and the possibility that VUR in children can resolve spontaneously. Methods: Review of the recent literature has demonstrated a growing concern that antibiotic prophylaxis may not lead to prevention of UTIs. Additionally, data indicate that renal scarring may not be preventable with antibiotic prophylaxis or even surgical correction of VUR. An overview of all of the current controversies is presented in this paper. Results: Does antibiotic prophylaxis lead to reduction in UTIs in children with VUR? To address this question, the National Institutes of Health have developed a randomized placebo-controlled study of children with VUR (the RIVUR Study), identified following the development of a UTI. Conclusions: There are far reaching consequences of the results of the RIVUR Study. If antibiotic prophylaxis does not prevent UTI in children with VUR, or lead to reduction in renal scarring, does identification of VUR provide any benefits? Perhaps appropriate treatment of UTI may be all that is necessary for preserving renal function. Final answers will have to wait until the completion of this study.

Original languageEnglish (US)
Pages (from-to)336-341
Number of pages6
JournalJournal of Pediatric Urology
Volume5
Issue number5
DOIs
StatePublished - Oct 2009

Keywords

  • Urinary tract infections
  • Vesicoureteral reflux

ASJC Scopus subject areas

  • Urology
  • Pediatrics, Perinatology, and Child Health

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