***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE We evaluated the difference in the febrile urinary tract infection rate in small children with dilating vesicoureteral reflux r and omly allocated to 3 management alternatives , including antibiotic prophylaxis , endoscopic treatment or surveillance only as the control . MATERIAL S AND METHODS At 23 centers a total of 203 children were included in the study , including 128 girls and 75 boys 1 to younger than 2 years . Vesicoureteral reflux grade III in 126 cases and IV in 77 was detected after a febrile urinary tract infection ( 194 ) after prenatal screening ( 9 ) .  Voiding cystourethrography and dimercapto-succinic acid scintigraphy  were done before r and omization and after 2 years . The febrile urinary tract infection rate was analyzed by the intent to treat principle . RESULTS We noted a total of 67  febrile recurrences in 42 girls and a total of 8 in 7 boys ( p = 0.0001 ) . There was a difference in the recurrence rate among treatment groups in girls with febrile infection in 8 of 43 ( 19 % ) on prophylaxis , 10 of 43 ( 23 % ) with endoscopic therapy and 24 of 42 ( 57 % ) on surveillance ( p = 0.0002 ) . In girls the recurrence rate was associated with persistent reflux after 2 years ( p = 0.0095 ) . However , reflux severity ( grade III or IV ) at study entry did not predict recurrence . CONCLUSIONS In this r and omized , controlled trial there was a high rate of recurrent febrile urinary tract infection in girls older than 1 year with dilating vesicoureteral reflux at study entry but not in boys .  Antibiotic prophylaxis and endoscopic treatment decreased the infection rate IMPORTANCE Existing data regarding the association between delayed initiation of antimicrobial therapy and the development of renal scarring are inconsistent . OBJECTIVE To determine whether delay in the initiation of antimicrobial therapy for febrile urinary tract infections ( UTIs ) is associated with the occurrence and severity of renal scarring . DESIGN , SETTING , AND PARTICIPANTS Retrospective cohort study that combined data from 2 previously conducted longitudinal studies ( the R and omized Intervention for Children With Vesicoureteral Reflux trial and the Careful Urinary Tract Infection Evaluation Study ) . Children younger than 6 years with a first or second UTI were followed up for 2 years . EXPOSURE Duration of the child 's fever prior to initiation of antimicrobial therapy for the index UTI . MAIN OUTCOMES AND MEASURES New renal scarring defined as the presence of photopenia plus contour change on a late dimercaptosuccinic acid renal scan ( obtained at study exit ) that was not present on the baseline scan . RESULTS Of the 482 children included in the analysis , 434 were female ( 90 % ) , 375 were white ( 78 % ) , and 375 had vesicoureteral reflux ( 78 % ) . The median age was 11 months . A total of 35 children ( 7.2 % ) developed new renal scarring . Delay in the initiation of antimicrobial therapy was associated with renal scarring ; the median ( 25th , 75th percentiles ) duration of fever prior to initiation of antibiotic therapy in those with and without renal scarring was 72 ( 30 , 120 ) and 48 ( 24 , 72 ) hours , respectively ( P = .003 ) . Older age ( OR , 1.03 ; 95 % CI , 1.01 - 1.05 ) , Hispanic ethnicity ( OR , 5.24 ; 95 % CI , 2.15 - 12.77 ) , recurrent urinary tract infections ( OR , 0.97 ; 95 % CI , 0.27 - 3.45 ) , and bladder and bowel dysfunction ( OR , 6.44 ; 95 % CI , 2.89 - 14.38 ) were also associated with new renal scarring . Delay in the initiation of antimicrobial therapy remained significantly associated with renal scarring even after adjusting for these variables . CONCLUSIONS AND RELEVANCE Delay in treatment of febrile UTIs and permanent renal scarring are associated . In febrile children , clinicians should not delay testing for UTI BACKGROUND Antibiotics are widely administered to children with the intention of preventing urinary tract infection , but adequately powered , placebo-controlled trials regarding efficacy are lacking . This study from four Australian centers examined whether low-dose , continuous oral antibiotic therapy prevents urinary tract infection in predisposed children . METHODS We r and omly assigned children under the age of 18 years who had had one or more microbiologically proven urinary tract infections to receive either daily trimethoprim-sulfamethoxazole suspension ( as 2 mg of trimethoprim plus 10 mg of sulfamethoxazole per kilogram of body weight ) or placebo for 12 months . The primary outcome was microbiologically confirmed symptomatic urinary tract infection . Intention-to-treat analyses were performed with the use of time-to-event data . RESULTS From December 1998 to March 2007 , a total of 576 children ( of 780 planned ) underwent r and omization . The median age at entry was 14 months ; 64 % of the patients were girls , 42 % had known vesicoureteral reflux ( at least grade III in 53 % of these patients ) , and 71 % were enrolled after the first diagnosis of urinary tract infection . During the study , urinary tract infection developed in 36 of 288 patients ( 13 % ) in the group receiving trimethoprim-sulfamethoxazole ( antibiotic group ) and in 55 of 288 patients ( 19 % ) in the placebo group ( hazard ratio in the antibiotic group , 0.61 ; 95 % confidence interval , 0.40 to 0.93 ; P = 0.02 by the log-rank test ) . In the antibiotic group , the reduction in the absolute risk of urinary tract infection ( 6 percentage points ) appeared to be consistent across all subgroups of patients ( P > or = 0.20 for all interactions ) . CONCLUSIONS Long-term , low-dose trimethoprim-sulfamethoxazole was associated with a decreased number of urinary tract infections in predisposed children . The treatment effect appeared to be consistent but modest across subgroups . ( Australian New Zeal and Clinical Trials Registry number , ACTRN12608000470392 . BACKGROUND AND OBJECTIVES The main objectives of the R and omized Intervention for Children with Vesicoureteral Reflux ( RIVUR ) trial were to evaluate the role of antimicrobial prophylaxis in the prevention of recurrent urinary tract infection ( UTI ) and renal scarring in children with vesicoureteral reflux ( VUR ) . We present a comprehensive evaluation of renal scarring outcomes in RIVUR trial participants . DESIGN , SETTING , PARTICIPANTS , & MEASUREMENTS This multicenter , r and omized , placebo-controlled trial enrolled 607 children aged 2 - 71 months with grade 1 - 4 VUR diagnosed after a first or second febrile or symptomatic UTI . Study participants received trimethoprim-sulfamethoxazole or placebo and were followed for 2 years . Renal scarring was evaluated by baseline and follow-up (99m)technetium dimercaptosuccinic acid ( DMSA ) renal scans that were review ed independently by two blinded reference radiologists . RESULTS At the end of the study , 58 ( 10 % ) of 599 children and 63 ( 5 % ) of 1197 renal units had renal scarring . New renal scarring did not differ between the prophylaxis and placebo groups ( 6 % versus 7 % , respectively ) . Children with renal scarring  were significantly older ( median age , 26 versus 11 months ; P=0.01 ) , had a second UTI before enrollment ( odds ratio [ OR ] , 2.85 ; 95 % confidence interval [ 95 % CI ] , 1.38 to 5.92 ) , were more likely to be Hispanic ( OR , 2.22 ; 95 % CI , 1.13 to 4.34 ) , and had higher grade s of VUR ( OR , 2.79 ; 95 % CI , 1.56 to 5.0 ) . The proportion of new scars in renal units with grade 4 VUR was significantly higher than in units with no VUR ( OR , 24.2 ; 95 % CI , 6.4 to 91.2 ) . CONCLUSIONS Significantly more renal scarring was seen in relatively older children and in those with a second episode of febrile or symptomatic UTI before r and omization . Preexisting and new renal scars occurred significantly more in renal units with grade 4 VUR than in those with low- grade or no VUR . Antimicrobial prophylaxis did not decrease the risk of renal scarring INTRODUCTION AND OBJECTIVE While open ureteral reimplantation remains the gold st and ard for surgical treatment of vesicoureteral reflux ( VUR ) , minimally invasive approaches offer potential benefits . This study evaluated the outcomes of children undergoing complex robot-assisted laparoscopic ureteral reimplantation ( RALUR ) for failed previous anti-reflux surgery , complex anatomy , or ureterovesical junction obstruction ( UVJO ) , and compared them with patients undergoing open extravesical repair . STUDY DESIGN Children undergoing complex RALUR or open extravesical ureteral reimplantation ( OUR ) were identified . Reimplantation was classified as complex if ureters : 1 ) had previous anti-reflux surgery , 2 ) required tapering and /or dismembering , or 3 ) had associated duplication or diverticulum . RESULTS Seventeen children underwent complex RALUR during a 24-month period , compared with 41 OUR . The mean follow-up was 16.6 ± 6.5 months . The RALUR children were significantly older ( 9.3 ± 3.7 years ) than the OUR patients ( 3.1 ± 2.7 years ; P < 0.001 ) . All RALUR patients were discharged on postoperative day one , while 24.4 % of children in the open group required longer hospitalization ( mean 1.3 ± 0.7 days ; P = 0.03 ) . Adjusting for age , there was no significant difference in inpatient analgesic usage between the two cohorts . Three OUR patients ( 7.3 % ) developed postoperative febrile urinary tract infection compared with a single child ( 5.9 % ) undergoing RALUR ( P = 1.00 ) . There was no significant difference in complication rate between the two groups ( 12.2 % OUR versus 11.8 % RALUR ; P = 1.00 ) . A postoperative cystogram was performed in the majority of RALUR patients , with no persistent VUR detected , and one child ( 6.7 % ) was diagnosed with contralateral reflux . DISCUSSION Reported VUR resolution rates following robot-assisted ureteral reimplantation are varied . In the present series , children undergoing RALUR following failed previous anti-reflux surgery , with complex anatomy , or UVJO experienced a shorter length of stay but had similar analgesic requirements to those undergoing open repair . Radiographic , clinical success rates and complication risk were comparable . This study had several limitations , aside from lack of r and omization . Analgesic use was limited to an inpatient setting , and pain scores were not assessed . Not all children underwent a postoperative VCUG , so the true radiographic success rate is unknown . A larger patient cohort with longer follow-up is necessary to determine predictors of radiographic and clinical failure . CONCLUSION Older children with a previous history of anti-reflux surgery were more likely to undergo RALUR . These children had success and complication rates comparable to younger patients following complex open extravesical reimplantation , which underscores the exp and ing role of robot-assisted lower urinary tract reconstructive surgery in the pediatric population INTRODUCTION  Voiding dysfunction after bilateral extravesical ureteral reimplantation for vesicoureteral reflux has long remained a concern . Robotic approach with improved visualization that enables focused and minimal dissection may help with this concern . OBJECTIVES To compare postoperative outcomes after bilateral robot-assisted laparoscopic ureteral reimplantation to unilateral robot-assisted laparoscopic ureteral reimplantation . STUDY DESIGN This was a retrospective study using data abstract ed from an institutional review board-approved registry prospect ively maintained at our institution since 2012 . Patient demographics , preoperative characteristics , and postoperative outcomes were analyzed . Patients with postoperative febrile urinary tract infection ( UTI ) underwent voiding cystourethrogram ( VCUG ) . Surgical success is defined as absence of febrile UTI or febrile UTI with negative VCUG . RESULTS 92 patients with a median follow-up of 14 ( 25th and 75th IQR 5 , 28 ) months . Median operative time ( 150 vs. 178 
    Output:
    
EVIDENCE SYNTHESIS Despite the striking results of previous studies revealing the ineffectiveness of CAP , more recent studies and their two fresh meta-analyses revealed a positive role for CAP in the contemporary management of VUR .
One of the most interesting findings is the redundant rising of endoscopic correction and its final settlement to real indicated cases .
The evidence in the literature showed a safe and effective use of laparoscopic and robot-assisted laparoscopic reimplantations .
CONCLUSIONS The goal of VUR treatment is to prevent the occurrence of febrile urinary tract infections and formation of scars in the renal parenchyma .