Primary VUR - To Treat or not to Treat?
I am providing the Latest Cochrane Systematic Review (2019) on â€˜Interventions in Primary VURâ€™. Some of the important points brought out in this review are:
Low-dose antibiotic prophylaxis compared to no treatment/placebo may make little or no difference to the risk of repeat symptomatic UTI.
Surgery plus antibiotic treatment may reduce the risk of repeat febrile UTI by 57% but there was little or no difference in the risk of new kidney defects detected.
Studies showed little or no difference in the risk of febrile UTI with endoscopic injection compared to antibiotics. Studies showed that there was no difference between the materials.
If medical therapy or surgical interventions have no real merit in the management of Primary VUR, then what options do we have for the treatment of Pr VUR? We have been repeatedly informed that some form of intervention may be required for Dilating VURâ€™s. Are we wrong in this assumption? Jatin Bhandari* and Steven G Docimo (2017) proposed that evaluation for VUR is not necessary or helpful except in the small subset of children whose UTIs have proven refractory to management of their other risk factors. (PDF of article provided, not for circulation).
The more I try to understand, the more confused I become. Can our esteemed colleagues help me understand where we stand and what we should do as regards Pr VUR?
With warm Regards,