title: Controversies in the management of vesicoureteral reflux: the rationale for the RIVUR study.
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.
authors: Division of Pediatric Urology, The Johns Hopkins School of Medicine, Baltimore, MD 21287, USA. rmathew1@jhmi.edu
authors: Ranjiv
authors: R
authors: Mathews
authors: Myra
authors: M
authors: Carpenter
authors: Russell
authors: R
authors: Chesney
authors: Alejandro
authors: A
authors: Hoberman
authors: Ron
authors: R
authors: Keren
authors: Tej
authors: T
authors: Mattoo
authors: Marva
authors: M
authors: Moxey-Mims
authors: Lee
authors: L
authors: Nyberg
authors: Saul
authors: S
authors: Greenfield
mesh_terms: D002648:Child; D006801:Humans; D014552:Urinary Tract Infections / Q000209:etiology / Q000517:prevention & control; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000175:diagnosis / Q000628:therapy*