Outcome of conservative treatment of primary vesicoureteral reflux in 87 Thai children in a single center

AIM: To evaluate the outcome of primary vesicoureteral reflux (VUR) using conservative treatment. METHODS: Eighty-seven children with primary VUR who had been treated with a conservative medical regimen and monitored through a yearly cystogram were recruited for the study. The study was conducted at the Pediatric Nephrology Clinic in Songklanagarind Hospital, the major tertiary care center in southern Thailand. Statistical analyses using Kaplan-Meier survival curves, chi-squared test, Fisher's exact test and multivariate analysis with Cox regression were performed. RESULTS: The study group consisted of 41 boys and 46 girls, with a total of 133 VUR. The age of the boys was significantly lower than that of the girls (P < 0.001). Resolution of the low grades (grades I-III) of VUR was significantly more frequent than that of the high grades (grades IV-V) (68/95, 72%vs 14/38, 37%; P < 0.001). Using the Kaplan-Meier survival analysis and log-rank test, the resolutions of VUR in boys versus girls, and age <1 years versus >or=1 years were not significantly different (P = 0.2252 and 0.4756, respectively). Low-grade VUR and unilateral VUR had significantly higher probabilities of resolution than high-grade VUR and bilateral VUR, respectively (P = 0.0041 and 0.0467, respectively). Multivariate Cox regression analysis indicated that among low-grade VUR, boys and unilateral VUR had significantly higher probabilities of resolution. Among the high-grade VUR, neither sex nor laterality had a significant effect on the probabilities of VUR resolution. CONCLUSION: This study offers more evidence that children with low-grade VUR have a higher chance of reflux resolution if they are boys and have only unilateral VUR. There is still no good guide for resolution of reflux in children with high-grade VUR.     

Is a repeat urine culture useful during antibiotic therapy for febrile urinary tract infection?

Aim:   To evaluate the cost-effectiveness of a repeat urine culture after a few days of antibiotic therapy in childhood urinary tract infection (UTI) in southern Thailand.
Methods:   A retrospective review of the medical record of children diagnosed with UTI aged less than 15 years in Songklanagarind Hospital from January 1995 to December 2004 was performed. Patient demographics were collected. The results of repeat urine culture after starting antibiotic were evaluated. The risk factors that indicated positive repeat urine culture were determined.
Results:   Four hundred and forty-nine patients (245 boys and 204 girls) with 533 UTI episodes were analyzed, of which 49 (9.2%) had a repeat urine culture with significant growth. Multivariate analysis showed that age less than 1 year, aetiological agents Enterococci spp., fever of more than 72 h, inappropriate antibiotics and kidney, ureter and bladder anomalies were the most significant risk factors for a positive repeat culture, while sex, vesicoureteral reflux and recurrent UTI episodes were not significant risk factors. If the treatment protocol during the study period had indicated that children with at least one of the above risk factors should receive a repeat urine culture, then only 356 cases (66.8% ± 2.0%) would have received a repeat test and $US 655 would have been saved, while five positive repeat urine cultures would have been missed.
Conclusion:   The present study in a group of Thai children indicates that a repeat urine culture during antibiotic therapy should still be recommended.