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Monitoring For Febrile UTI Vs Post Injection VCUG In Patients Treated With Subureteric Dextranomer/hyaluronic Acid
Erin C. Grantham, MD, Michelle P. Kallis, BA, Brad P. Moore, MD, Alexander Lubin, MD, Paul F. Zelkovic, MD, Israel Franco, MD.
New York Medical College, Valhalla, NY, USA.

BACKGROUND:
Prevention of febrile UTIs is the primary indication for addressing vesicoureteral reflux (VUR) in children. The majority of children surgically treated for VUR undergo dextranomer hyaluronic acid (Dx-HA) injections. The gold standard for success has been VUR absent on follow up VCU. We propose that using less invasive post operative ultrasound, coupled with close monitoring for recurrence of febrile UTI, nets the same benefit.
METHODS:
A retrospective chart review was performed of patients who had Dx-HA injections for VUR from 2007-2011. Post injection, all patients underwent a renal bladder ultrasound at six weeks, and then prophylactic antibiotics were discontinued. Repeat VCU was only performed if patients had evidence of hydronephrosis, new renal scarring, or a febrile UTI.
RESULTS:
92 patients underwent Dx-HA injection into 162 renal units using a previously described double-hit technique. Seven patients (8%) underwent VCU after Dx-HA injection. Follow up ranged from 8 to 59 (mean 29) months.
Two patients had febrile UTIs at 5 and 15 months post injection respectively. One patient had a VCU showing persistent grade 2 VUR on one side and contralateral resolution. The other patient had a history of treated posterior urethral valves and ongoing dysfunctional elimination syndrome. 90 patients had no febrile UTIs.
CONCLUSIONS:
By using selective indications for VCU, 85 patients (92%) were spared the radiation and discomfort of VCU. As only 2 patients had febrile UTI after Dx-HA, and as febrile UTI is the most concerning common consequence of VUR, we feel that monitoring for febrile UTI and selective VCU is appropriate.


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