Predictive factors of early spontaneous resolution in children with primary vesicoureteral reflux.
OBJECTIVE
Questions regarding the efficacy and safety of long-term prophylactic antibiotics and the option of minimally invasive therapy have increased clinical emphasis on predicting early resolution in patients with vesicoureteral reflux. We reviewed multiple potential prognostic factors in addition to grade to enhance predictive ability regarding early vesicoureteral reflux resolution.


METHODS
Medical records and cystograms from 324 children (257 girls and 67 boys) with primary vesicoureteral reflux were reviewed. Multiple factors were analyzed with respect to outcome and multivariable dependent tables were constructed to enhance the prediction of vesicoureteral reflux resolution.


RESULTS
Mean +/- SD age at diagnosis was 2.3 +/- 2.1 years and followup was 1.7 +/- 2.8 years. Reflux grade was significantly associated with resolution (p <0.001). Multivariate analysis stratifying by grade demonstrated that a bladder volume at reflux onset on the initial cystogram of greater than 50% of predicted bladder capacity (p <0.001), age younger than 2 years at diagnosis (p = 0.003) and history of prenatal hydronephrosis (p <0.001) were significant factors predicting resolution within 2 years. Multivariable tables using age, bladder volume at reflux onset and grade demonstrated that children younger than 2 years at diagnosis and volume at onset greater than 50% of predicted bladder capacity had a higher early resolution rate for grades 2 (p = 0.012) and 3 (p <0.001) reflux.


CONCLUSIONS
Initial reflux grade, bladder volume at reflux onset, age at diagnosis and history of prenatal hydronephrosis were shown to be independent factors affecting the resolution rates of vesicoureteral reflux. The multivariable tables permit improved individualized prediction of resolution in patients with grades 2 and 3 reflux.
Knudson
Matthew J
MJ
Division of Pediatric Urology, Department of Urology, University of Iowa, Iowa City, Iowa 52242-1089, USA.
Austin
J Christopher
JC
McMillan
Zeb M
ZM
Hawtrey
Charles E
CE
Cooper
Christopher S
CS
D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D012075:Remission, Spontaneous; D018709:Statistics, Nonparametric; D014718:Vesico-Ureteral Reflux / Q000503:physiopathology*