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Management and Screening of Primary Vesicoureteral Reflux in Children: AUA Guideline Revised, 2010Panel Members:Consultants:Craig A. Peters, M.D., Chair Steven J.

Skoog, M.D., Vice-ChairMireya Diaz, Ph.D. Linda Whetter, D.V.M, Ph.D.

Suzanne Pope, M.B.A.Billy S. Arant, Jr., M.D.

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Elder, M.D., Facilitator R. Guy Hudson, M.D. Lorenzo, M.D. Ellen Shapiro, M.D. Snodgrass, M.D.AUA Staff: Heddy Hubbard, Ph.D., M.P.H. Michael Folmer Cynthia Janus, M.L.S.

Kadiatu Kebe Abid Khan, M.H.S. Marni Zuckerman, M.A.VUR Guideline SummaryVUR Guideline Summary Contents Introduction.2 Initial Evaluation of the Child with VUR.4 Initial Management of the Child with VUR.9 Follow-up Management of the Child with VUR. 13 Interventions for the Child with Breakthrough UTI (BT-UTI). 15 Surgical treatment of VUR.

17 Follow-up Management Following Resolution of VUR. 18 Screening for VUR in Siblings and Neonates with Prenatal Hydronephrosis.

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20 Summary and Conclusions. 23 Conflict of Interest Disclosures. 27 AUA Guideline for Management and Screening of Primary Vesicoureteral Reflux in Children. 28 References. 301 Copyright © 2010 American Urological Association Education and Research, Inc.®VUR Guideline SummaryIntroduction In 1997, the American Urological Association (AUA) published the Guideline on the Management of Primary Vesicoureteral Reflux in Children.1 Since that time there has been an expanding body of literature involving not only the evaluation and the management of vesicoureteral reflux (VUR) but also the role of screening in its management.

For this reason, the AUA appointed a Panel of experts to update the 1997 document and elected to expand its scope to include guidelines for the screening of siblings of children with vesicoureteral reflux (VUR) and of neonates/infants with prenatally diagnosed hydronephrosis. A literature search, review of the evidence, and data extraction from the relevant clinical studies and case series were performed. Extracted data underwent meta-analysis to determine the outcomes related to five topics: 1) management of children over one year of age with VUR; 2) evaluation and management of infants with VUR; 3) management of children with VUR and Bladder and Bowel Dysfunction (BBD); 4) screening of siblings and offspring of patients with VUR; and 5) screening of neonates and infants with prenatal hydronephrosis. This document summarizes the guideline statements derived from a meta-analysis. Additional chapters (1-5) provide a detailed summary of each of these topics.From the evidence and expert opinion, the Panel drafted guideline statements.

According to AUA nomenclature, these statements are graded with respect to the degree of flexibility in application. A 'standard' is the most rigid treatment policy. A 'recommendation' has significantly less rigidity and an 'option' the least. These terms are defined as follows: 1.Standard: A guideline statement is a standard if (1) the health outcomes of the alternative interventions are sufficiently well-known to permit meaningful decisions and 2 Copyright © 2010 American Urological Association Education and Research, Inc.®VUR Guideline Summary(2) there is virtual unanimity among panel members about which intervention is preferred.

Pete Can Fix-It is the fourth in a series of ten e-books containing the complete collection of short stories written by Raymond F. These stories span the years from 1941-1974, and this is the first time this entire collection has ever been made available. Notable stories in this collection are: Pacer I, Pete Can Fix-it, Encroachment, A Stone and a Spear, Human Error, Last Train to Alpha Centari, and Pet.With our modern technology, we can relate to the ones and zeros that travel through cyber space transmitting messages, images and videos to distant destinations; in Jones’ story The Last Train to Alpha Centari, this technology is ratcheted up to included trains traveling between galaxies carrying people, cargo and livestock. It’s not so futuristic when you consider how the books you download from Amazon arrive at your Kindle. Even now, are there people and cargo all around us—traveling, but just in another dimension?Two things to watch for as you read this collection of stories, as well as the other nine books: vocabulary and colloquialism. Jones writes with a vocabulary that is pertinent to the story being told, but which you will probably find baffling as they’re words you’ve likely not encounter before.

Hint: make a list of the words. Secondly, note the amusing colloquialism which was in vogue during the 40s, 50s and 60s.Raymond F.