title: The long-term incidence of urinary tract infection after endoscopic management of vesicoureteral reflux.
abstract: OBJECTIVE
  To evaluate the long-term urinary tract infection (UTI) rates after endoscopic correction of vesicoureteral reflux and the possible risk factors for urinary infection.
  
  
  METHODS
  A retrospective study of patients who underwent endoscopic management of vesicoureteral reflux at a single institution from 2001 to 2011 was performed. Patients were followed up for a minimum of 1 year. Voiding cystourethrograms were completed 3 months postoperatively. UTI questionnaire pertaining to the patient's UTI history before and after the surgery was mailed to each patient. Data were first evaluated looking only at culture-confirmed UTIs, and a second analysis included all patient-reported and culture-confirmed urinary infections. Factors considered in the analysis included sex, age, preoperative dimercaptosuccinic acid (DMSA) scan, reflux on postoperative voiding cystourethrogram, voiding dysfunction, and preoperative reflux grade.
  
  
  RESULTS
  Data on 175 patients for a minimum of 1 year were collected. There were 34 of 175 confirmed UTIs after endoscopic management, and 11 confirmed febrile UTIs. There were no significant predictors of febrile or afebrile UTIs in this group. Fifty-three of 175 patients (30%) experienced any UTI, 19 of which were febrile (10%). In this group, recurrent reflux was the only significant predictor of UTI (P=.03) and febrile UTIs (P=.04). Patients with more UTIs preoperatively were more likely to have a postoperative febrile UTI.
  
  
  CONCLUSIONS
  Rates of UTI and febrile UTI in endoscopic management are similar and no better than those for open ureteral reimplantation. Longer follow-up suggests an association of recurrent reflux and preoperative UTI rates as predictors of postoperative febrile UTIs. These patients benefit from closer postoperative observation.
authors.affiliation: Oregon Health & Science University, Portland, OR.
authors.forename: Adrienne M
authors.initials: AM
authors.lastname: Heckler
authors.affiliation: Oregon Health & Science University, Portland, OR.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sung
authors.affiliation: Oregon Health & Science University, Portland, OR.
authors.forename: Sean
authors.initials: S
authors.lastname: Watters
authors.affiliation: Oregon Health & Science University, Portland, OR.
authors.forename: Ann
authors.initials: A
authors.lastname: Martinez Acevedo
authors.affiliation: Oregon Health & Science University, Portland, OR.
authors.forename: Michael
authors.initials: M
authors.lastname: Conlin
authors.affiliation: Oregon Health & Science University, Portland, OR. Electronic address: skoogs@ohsu.edu.
authors.forename: Steven
authors.initials: S
authors.lastname: Skoog
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D016208:Databases, Factual; D004724:Endoscopy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D013995:Time; D013997:Time Factors; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis / Q000601:surgery*; D055815:Young Adult