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,