Re: Outcome of antibiotic prophylaxis discontinuation in patients with persistent vesicoureteral reflux. Editorial comment.

摘要

This retrospective study adds little clarity to the controversy surrounding the need for treatment of older children with VUR. Renal scarring is a major, if not the major, concern in these children and should be documented with a radionuclide DMSA scan. Renal ultrasound cannot accurately determine renal scarring and has little place in the ongoing evaluation of patients with reflux. DMSA scanning was not uniformly performed in this series. Furthermore, since an initial DMSA scan is not reported, a major risk factor for additional-infections remains unknown, ie renal scar at the time of clinical presentation. The assessment of dysfunctional voiding was surprisingly informal, given the fact that a reproducible symptom scoring system was developed in Toronto. We do not really know who had voiding dysfunction in this cohort.