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To screen or not to screen for vesicoureteral reflux in children with ureteropelvic junction obstruction: a systematic review

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Abstract

Ureteropelvic junction obstruction (UPJO) and vesicoureteral reflux (VUR) are the most common uropathies. The co-occurrence of both anomalies has led to the practice of screening for VUR in children with UPJO to prevent deterioration of kidney function due to renal scarring following urinary tract infections (UTIs). We determined the prevalence of VUR in children with UPJO for a critical assessment of VUR screening by voiding cystourethrography (VCUG). A systematic search strategy in MEDLINE, EMBASE, and CENTRAL was carried out for all articles that included VCUG, and renal scintigraphy or any other appropriate imaging technique for the diagnosis of UPJO. Twenty studies were eligible for inclusion. We found a pooled prevalence for VUR of 8.2 % (95 % CI = 3.6–12.7), about a threefold increase compared to the general pediatric population. VUR occurred bilateral or contralateral to the kidney with UPJO in 5.7 % (95 % CI = 3.0–8.5), equivalent to 75 % of all children with VUR. Considering the effect size of VUR treatment with antibiotics, about 207 and 278 children would need to undergo VCUG to prevent one febrile UTI and one case of renal scarring by 1–2 years, respectively.

Conclusion: Against this background, screening for VUR needs to be scrutinized and restricted to selected risk groups.

What is known:

• Screening of patients with ureteropelvic junction obstruction (UPJO) for vesicoureteral reflux (VUR) is recommended based on a small number of repeatedly cited studies.

• The lack of conclusive evidence results in different treatment strategies and leads to difficulties when communicating diagnoses and treatment options to parents.

What is new:

• A robust prevalence for VUR in children with UPJO based on all published evidence and the resulting number needed to screen are given for decision-making in daily clinical practice.

• The results may be a precursor for implementation into guidelines.

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Abbreviations

CI:

95 % confidence interval

ESRD:

End-stage renal disease

UPJO:

Ureteropelvic junction obstruction

VUR:

Vesicoureteral reflux

VCUG:

Voiding cystourethrography

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Acknowledgements

We would like to thank Gail Higgins, the Trials Search Co-ordinator of the Cochrane Renal Group and Christina Walter, the Search Co-ordinator at the University Hospital Tuebingen (Germany) for developing and running the search strategy used in this review.

Authors’ contributions

M. Weitz (MW) and M. Schmidt (MS) contributed equally to the manuscript. MW participated in design of the review, analysis, and interpretation of the data and writing of the review. MS participated in extraction and analysis of the data and writing of the review. Both authors have read and approved the final version of the manuscript.

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  1. Department of Nephrology, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland

    Marcus Weitz & Maria Schmidt

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Correspondence to Marcus Weitz.

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Weitz, M., Schmidt, M. To screen or not to screen for vesicoureteral reflux in children with ureteropelvic junction obstruction: a systematic review. Eur J Pediatr 176, 1–9 (2017). https://doi.org/10.1007/s00431-016-2818-3

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