Guidelines for the medical management of pediatric vesicoureteral reflux

Abstract

Abbreviations & Acronyms BBD = bladder and bowel dysfunction CAKUT = congenital anomalies of the kidney and urinary tract CAP = continuous antibiotic prophylaxis DMSA = dimercaptosuccinic acid fUTI = febrile urinary tract infection RN = reflux nephropathy SFU = Society for Fetal Urology UTI = urinary tract infection VCUG = voiding cystourethrography VUR = vesicoureteral reflux Correspondence: HideshiAbstract: Urinary tract infection is a bacterial infection that commonly occurs in children. Vesicoureteral reflux is a major underlying precursor condition of urinary tract infection, and an important disorder in the field of pediatric urology. Vesicoureteral reflux is sometimes diagnosed postnatally in infants with fetal hydronephrosis diagnosed antenatally. Opinions vary regarding the diagnosis and treatment of vesicoureteral reflux, and diagnostic procedures remain debatable. In terms of medical interventions, options include either follow-up observation in the hope of possible spontaneous resolution of vesicoureteral reflux with growth/development or provision of continuous antibiotic prophylaxis based on patient characteristics (age, presence/absence of febrile urinary tract infection, lower urinary tract dysfunction and constipation). Furthermore, there are various surgical procedures with different indications and rationales. These guidelines, formulated and issued by the Japanese Society of Pediatric Urology to assist medical management of pediatric vesicoureteral reflux, cover the following: epidemiology, clinical practice algorithm for vesicoureteral reflux, syndromes (dysuria with vesicoureteral reflux, and bladder and rectal dysfunction with vesicoureteral reflux), diagnosis, treatment (medical and surgical), secondary vesicoureteral reflux, long-term prognosis and reflux nephropathy. They also provide the definition of bladder and bowel dysfunction, previously unavailable despite their close association with vesicoureteral reflux, and show the usefulness of diagnostic tests, continuous antibiotic prophylaxis and surgical intervention using site markings.

Antireflux endoscopic injection therapy in adult patients via modified hydrodistention implantation techniques adopted for the dilated ureteral orifice: a retrospective single-center study

“…3 [3] 12 [7] total 5 [1] 8 [5] 3 [3] 16 [9] Abbreviations: HD hydrodistension grade, VUR vesicoureteral re ux Vesicoureteral re ux timing is presented in brackets as, n [ lling vesicoureteral re ux]…”

“…In addition, the use of endoscopic injection therapy has increased since the injectable agents and techniques have been re ned, resulting in subureteral transurethral injection (STING), hydrodistension implantation technique (HIT), and double-HIT procedure [6][7][8]. Currently, this minimally invasive therapy is a new option for the treatment of VUR in children [9].…”

Adherence and Acceptability of an Oral Antibiotic Used for the Prevention of Pediatric Urinary Tract Infection in Japan

“…Continuous antimicrobial prophylaxis has been a longstanding management strategy for pediatric patients with vesicoureteral reflux (VUR) and urinary tract infection (UTI)—a common health care-associated adverse event and the leading nosocomial complication following pediatric urological surgery [ 1 , 2 , 3 , 4 ]. In a randomized interventional trial of pediatric patients with VUR, prophylaxis was associated with a two-fold reduction in risk for recurrent UTIs [ 5 ].…”

“…In a randomized interventional trial of pediatric patients with VUR, prophylaxis was associated with a two-fold reduction in risk for recurrent UTIs [ 5 ]. Although there is no clear consensus on duration of antimicrobial prophylaxis for VUR [ 4 , 6 ], periods of about one year of continuous prophylaxis have been reported [ 7 , 8 , 9 ]. Shorter periods of several days continuous antimicrobial prophylaxis treatment are currently recommended after postoperative (open and laparoscopic) pediatric urological surgery in the updated Japanese urological guidelines [ 10 ].…”

Antireflux endoscopic injection therapy in post-pubertal patients via techniques adopted for the dilated ureteral orifice: a retrospective single-center study

“…In addition, the use of endoscopic injection therapy has increased since the injectable agents and techniques have been refined, resulting in subureteral transurethral injection (STING), hydrodistension implantation technique (HIT), and double-HIT procedure [6][7][8]. Currently, this minimally invasive therapy is a new option for the treatment of VUR in children [9].…”