Cessation of Vesicoureteral Reflux For 5 Years in Infants and Children Allocated to Medical Treatment

Tamminen-Möbius, T.; Brunier, E.; Ebel, Kl.-D.; Lebowitz, Robert L.; Olbing, H; Seppänen, Ulpu; Sixt, Rune

doi:10.1016/s0022-5347(17)36997-5

Cited by 174 publications

(64 citation statements)

References 4 publications

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“…McLorie and colleagues 14 showed that 93% of patients with grade 4 and 83% of those with grade 3 VUR had persistent reflux after 2 years of observation therapy, and 70% with grade 4 and 50% with grade 3 VUR had persistent reflux after 5 years of this therapy. Tamminen-Möbius and colleagues 15 also showed that 84% of children with grades 3 and 4 VUR still had reflux after 5 years of observation therapy. The only alternative to management with low-dose antibiotic prophylaxis was open surgery.…”

Section: Discussionmentioning

confidence: 92%

Endoscopic treatment of vesicoureteral reflux in children with subureteral dextranomer/hyaluronic acid injection: a single-centre, 7-year experience

et al. 2012

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Background:The goals of medical intervention in patients with vesicoureteral reflux are to allow normal renal growth, prevent infections and pyelonephritis, and prevent renal failure. We present our experience with endoscopic treatment of vesicoureteral reflux in children by subureteral dextranomer/hyaluronic acid copolymer injection.Methods: Under cystoscopic guidance, dextranomer/hyaluronic acid copolymer underneath the intravesical portion of the ureter in a subureteral or submucosal location was injected in patients undergoing endoscopic correction of vesicoureteral reflux.Results: A total of 282 patients (120 boys and 162 girls) underwent the procedure. There were 396 refluxed ureters altogether. The mean age of patients was 4.9 years. The mean overall follow-up period was 44 months. Among the 396 ureters treated, 76% were cured with a single injection. A second and third injection raised the cure rate to 93% and 94%, respectively. Twenty-two (6%) ureters failed all 3 injections, and were converted to open surgery. Conclusion:Endoscopic treatment of vesicoureteral reflux can be recommended as a first-line therapy for most cases of vesicoureteral reflux, because of the short hospital stay, absence of complications and the high success rate.Contexte : Chez des patients qui présentent un reflux vésico-urétéral, les objectifs de l'intervention médicale sont de permettre une croissance rénale normale, de prévenir les infections, la pyélonéphrite et l'insuffisance rénale. Nous présentons notre expéri-ence du traitement endoscopique du reflux vésico-urétéral par injection infraurétérale du copolymère dextranomère-acide hyaluronique chez des enfants.Méthodes : Sous cystoscopie, le copolymère dextranomère-acide hyaluronique a été injecté sous la portion intravésicale de l'uretère dans la région infra-urétérale ou sousmuqueuse chez des patients qui devaient subir une correction endoscopique pour reflux vésico-urétéral.Résultats : En tout, 282 patients (120 garçons et 162 filles) ont subi l'intervention, pour un total de 396 uretères touchés par le reflux. L'âge moyen des patients était de 4,9 ans. Le suivi global moyen a été de 44 mois. Parmi les 396 uretères traités, 76 % ont été corrigés au moyen d'une simple injection. Une seconde, puis une troisième injection ont porté le taux de guérison à 93 % et à 94 %, respectivement. Vingt-deux uretères (6 %) n'ont pas répondu aux 3 injections et pour ces cas, on a utilisé la chirurgie ouverte. Conclusion :Le traitement endoscopique du reflux vésico-urétéral peut être recommandé en traitement de première intention dans la plupart des cas de reflux vésico-urétéral en raison de la brièveté du séjour hospitalier, de l'absence de complications et du taux de réussite élevé.

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Section: Discussionmentioning

confidence: 92%

Endoscopic treatment of vesicoureteral reflux in children with subureteral dextranomer/hyaluronic acid injection: a single-centre, 7-year experience

et al. 2012

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“…In the Birmingham study of children with dilated reflux, 16 37 (49%) of 75 children randomly allocated to nonoperative treatment were free of reflux at the 5-year investigation. In the International Reflux Study in Children, 17 the corresponding numbers were 57 (25.0%) of 228. Goldraich and Goldraich 14 described disappearance of reflux at age 5 years in 42% to 48% of patients and at age 10 years in 55% to 60% of children with dilated reflux.…”

Section: Commentmentioning

confidence: 97%

Disappearance of Vesicoureteral Reflux in Children

Wennerström¹,

Hansson²,

Jodal³

et al. 1998

Arch Pediatr Adolesc Med

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“…It was long believed that vesicoureteric reflux (VUR) of infected urine or even sterile VUR of high grade per se can lead to renal scarring and progressive chronic kidney disease (38)(39)(40). Lately, however, such a role of VUR has been questioned by many authors (41)(42)(43)(44)(45)(46)(47)(48)(49)(50). It is no wonder that the diagnostic algorithm for children after UTI has changed, and it is hard to expect that a unified approach can be unanimously agreed upon.…”

Section: Management Of Children After Urinary Tract Infectionmentioning

confidence: 99%

“…Those who believe that VUR as such is an important risk factor for renal scarring still favor its detection in all children after proven UTI (51). On the other hand, there is a growing number of pediatric nephrologists who prefer screening for scars (mostly using a 99mTc-dimercaptosuccinic acid renal scan (DMSA)), and recommend cystography (preferably Xray voiding cystourethrography (VCUG)) only in those cases where renal scarring has been confirmed (41)(42)(43)(44)(45)(46)(47)(48)(49)(50). Regardless which approach one finds closer to one's opinion, there should nevertheless be general agreement that the ongoing search for patient-friendly investigations should be an imperative in taking care of the children in question.…”

Section: Management Of Children After Urinary Tract Infectionmentioning

confidence: 99%