title: Febrile urinary tract infection after ureteroneocystostomy: a contemporary assessment at a single institution.
abstract: OBJECTIVE
  Febrile urinary tract infection represents significant morbidity in patients with vesicoureteral reflux, especially following open surgical or endoscopic treatment. The reported incidence of febrile urinary tract infection after ureteroneocystostomy varies from 10% to 24%. We investigated the incidence of febrile urinary tract infection following ureteroneocystostomy in a contemporary, single institution series.
  
  
  METHODS
  We retrospectively reviewed medical records of 395 consecutive patients undergoing ureteroneocystostomy for primary vesicoureteral reflux at our institution between 2002 and 2007. We examined demographic, diagnostic and operative data, including presence of postoperative febrile urinary tract infection. A Cox proportional hazards model was performed to assess predictors of febrile urinary tract infection following ureteroneocystostomy.
  
  
  RESULTS
  Ureteroneocystostomy was performed in 395 patients (673 ureters) at a mean age of 58 months. The most common reflux grade was III (41%). The incidence of postoperative febrile urinary tract infection was 4.6% at a mean followup of 15 months. Postoperative dysfunctional elimination syndrome was a significant predictor of febrile urinary tract infection (HR 3.8, 95% CI 1.2-12, p = 0.02), and was identified in 58 of 340 toilet trained children (15% overall). Age at diagnosis, initial presentation, age at surgery, indication for surgery, reflux grade, laterality, surgical technique and preoperative dysfunctional elimination syndrome were not predictive of postoperative febrile urinary tract infection.
  
  
  CONCLUSIONS
  The incidence of febrile urinary tract infection following ureteroneocystostomy may be lower than previously reported. The presence of postoperative dysfunctional elimination syndrome is a significant predictor of postoperative febrile urinary tract infection.
authors.affiliation: Division of Pediatric Urology, Monroe Carell, Jr Children's Hospital at Vanderbilt, Nashville, Tennessee 37232-9820, USA.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Whittam
authors.forename: James R
authors.initials: JR
authors.lastname: Thomasch
authors.forename: John H
authors.initials: JH
authors.lastname: Makari
authors.forename: Stacy T
authors.initials: ST
authors.lastname: Tanaka
authors.forename: John C
authors.initials: JC
authors.lastname: Thomas
authors.forename: John C
authors.initials: JC
authors.lastname: Pope
authors.forename: Mark C
authors.initials: MC
authors.lastname: Adams
authors.forename: John W
authors.initials: JW
authors.lastname: Brock
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003559:Cystostomy / Q000009:adverse effects*; D005260:Female; D005334:Fever / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D014513:Ureter / Q000601:surgery*; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000209:etiology*; D014718:Vesico-Ureteral Reflux / Q000601:surgery*