Presentation Authors: Smruthi Ramesh*, Melissa McGrath, Kornelia Palczek, Hamilton, Canada, Luis H Braga, Hamilton, ON
Introduction: Patients with VUR are routinely seen at follow-up visits with serial ultrasounds (US) after stopping continuous antibiotic prophylaxis (CAP). Since there is little evidence to support this practice, we sought to examine the impact of US findings on the clinical management of VUR patients at follow-up visits.
Methods: A prospectively collected VUR database from 2009-2018 was reviewed. We identified 218 patients who have stopped CAP. Variables collected included age at CAP discontinuation, follow-up time, gender, circumcision status, SFU grades (low [I-II] vs high [III-IV]) and febrile urinary tract infection (fUTI). Change in management was defined as surgical intervention to treat symptomatic VUR or restarting CAP.
Results: The median age at CAP discontinuation and median follow-up time were 20 months (IQR: 19) and 42 months (IQR: 33) respectively. Of 218 VUR patients, 105 (48%) were male and 38 (36%) circumcised. There were 135 (62%) patients with unremarkable serial US findings and 83 (38%) with hydronephrosis (HN). Patients with normal vs. abnormal US findings experienced similar rates of change in management (11% vs. 8%, p=0.7). In patients with normal US findings, those with fUTI were more likely to experience a change in management than those without (52% vs. 0%, p < 0.01). Of patients with abnormal US findings, 58/83 (70%) had low grade HN. In this group, change in management was more likely to occur in patients with fUTI vs. those without (50% vs. 2%, p < 0.01). Classification of low vs. high HN did not have a significant effect on change in management (9% vs. 8%, p=1.0).
Conclusions: In 2/3 of VUR patients, US findings were unremarkable and did not impact clinical management. The driving factor for change in management was fUTI post-CAP discontinuation. Thus, asymptomatic VUR patients may not require routine follow-ups with renal US after stopping CAP.