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19–22 APRIL, 2017, BARCELONA, SPAIN
S4: VESICOURETERAL REFLUX 1
Moderators: Francisco de Badiola (Argentina), Gundela Holmdahl (Sweden)
ESPU Meeting on Thursday 20, April 2017, 08:20–08:56
08:20–08:23
S4-1 (PP)
★
A REEVALUATION OF THE RIVUR TRIAL
WITH A VALIDATED RISK STRATIFICATION MODEL
Zhan Tao (peter) WANG
1
, Yasaman ALAM
1
, Guy HIDAS
2
, Irene MCALEER
1
and Antoine KHOURY
1
1) Children’s Hospital of Orange County, Urology, Orange, USA - 2) Hadassah and Hebrew University Medical Center,
Urology, Jerusalem, ISRAEL
PURPOSE
The Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trial showed a 50%
reduction in the risk for recurrent urinary tract infection (UTI) in children who received prophylaxis
compared to placebo. This conclusion is heavily debated. We reevaluated the RIVUR data using
a validated risk stratification model.
MATERIAL AND METHODS
Data from all 607 children were used. We stratified the children into low, intermediate and high risk
categories based on gender, circumcision status, VUR grade and bladder bowel dysfunction. Febrile
or symptomatic UTI recurrence in our stratified placebo and prophylaxis groups were compared us-
ing Fisher’s exact test. Kaplan-Meier curves and a log-rank test was used for time-to-event analysis.
RESULTS
There were 389 (64.6%), 132 (21.9%) and 50 (8.3%) children stratified into low, intermediate and
high risk categories. The rate of recurrent UTI was not significantly different in low risk children
receiving either placebo or prophylaxis (Table 1). Whereas intermediate risk children receiving
prophylaxis had a 20% absolute reduction in recurrence compared to placebo. Similarly, there were
twice as many recurrent UTIs in high risk children on placebo; however this difference was not
significant due to the small sample size. Time-to-event analysis showed no difference in recurrence
between the stratified categories with placebo or prophylaxis (p=0.045).
Table 1: Recurrent Febrile or Symptomatic UTI According to Risk and Treatment Groups
Risk Group
Placebo (%)
Prophylaxis (%)
p Value
Low
37/193 (19.4)
27/196 (13.9)
0.172
Intermediate
24/80 (28.2)
7/83 (8.5)
0.001
High
10/25 (40)
5/25 (20)
0.217
CONCLUSIONS
The majority (64.6%) of the children in the RIVUR trial fell into the low risk category and do not
benefit from prophylaxis, while intermediate risk children receiving prophylaxis showed a 20%
absolute reduction in recurrence. Therefore an individualized approach is required for the optimal
management of vesicoureteral reflux.