Imaging and treatment strategies for children after first urinary tract infection.
OBJECTIVE
To highlight recent controversies regarding the rationale and effectiveness of imaging and treatment strategies for children who experience a first urinary tract infection.


RESULTS
The yield of renal ultrasound for children who have had a first urinary tract infection is relatively low, and the most commonly identified abnormalities are of unclear clinical significance. If concerned about renal ultrasound abnormalities, clinicians should not be reassured by a normal late trimester prenatal ultrasound because its negative predictive value is not sufficiently high. Vesicoureteral reflux is neither necessary nor sufficient for developing renal scars. Some pyelonephritis and renal scarring may be related to vesicoureteral reflux that is missed by standard voiding cystourethrogram but detectable during positional instillation of contrast cystography. Dimercaptosuccinic acid scans provide important information about presence of pyelonephritis and renal scars, and have high negative predictive value for ruling out high-grade (III-V) vesicoureteral reflux. Antimicrobial prophylaxis may not be effective for preventing recurrent infections and may result in antimicrobial resistance. Endoscopic therapy (Deflux) has demonstrated moderate success in correcting vesicoureteral reflux, but little is known about its impact on recurrent infection and renal scarring.


CONCLUSIONS
Debate continues about optimal imaging strategies after first urinary tract infection. More research is needed on the effectiveness of interventions designed to prevent recurrent infections and renal scarring.
Keren
Ron
R
Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, and Department of Pediatrics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine 19104, USA. keren@email.chop.edu
D019072:Antibiotic Prophylaxis; D002648:Child; D003911:Dextrans / Q000627:therapeutic use; D004724:Endoscopy; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use; D019736:Prostheses and Implants; D004113:Succimer; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy*; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis / Q000628:therapy
D003911:Dextrans; C094535:deflux; D006820:Hyaluronic Acid; D004113:Succimer