Interventions for primary vesicoureteric reflux

Hodson, Elisabeth M; Wheeler, Danielle M; Smith, Grahame; Craig, Jonathan C.; Vimalachandra, Dushyanthi

doi:10.1002/14651858.cd001532.pub3

Cited by 83 publications

(61 citation statements)

References 44 publications

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“…It is still uncertain whether or not the treatment of children with VUR has clinically significant benefits and the additional benefits of surgery over antibiotics alone appear to be small at best (1).…”

Section: Discussionmentioning

confidence: 99%

“…The main goal of this management is to prevent parenchymal renal damage through either continuous antibiotic prophylaxis or reflux correction via surgical or endoscopic interventions. According to recent meta-analyses, it is uncertain whether renal scarring or end-stage renal disease (ESRD) can be prevented with the treatment of VUR (1,2). Borges Bezerra Teixeira and colleagues study showed no relation between VUR grade and the presence of renal scarring (3).…”

Section: Introductionmentioning

confidence: 99%

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Management and Outcome of Vesicoureteral Reflux: A 14-Year Experience

Nassiri

Ghavami-Adel

2018

Iran J Pediatr

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Objectives: Vesicoureteral reflux is a common problem in young children. The increased risk of urinary tract infection in these patients is the main cause of renal parenchymal damage. The main managements are prophylactic antibiotics and different surgical interventions. In this study, we evaluate the results of surgical intervention in VUR patients. Methods: This is a cross sectional retrospective study of all our patients with primary reflux who have been managed surgically between 2002 and 2016. Results: Of 420 patients with VUR, 207 were managed surgically. Eighteen (8.7%) patients with bilateral reflux before intervention and persistent reflux (grade II or III) after intervention, progressed to end stage renal disease (ESRD). There was no significant relation between the grade of reflux, the serum level of the creatinine or frequency of positive urine culture, and progression to ESRD, while a significant relation existed between grade of post-operative VUR and post-operative positive urine culture with ESRD (P = 0.000). Conclusions: It seems that surgery cannot prevent renal damage in some cases of VUR. Close follow up after surgical intervention particularly in those with persistent reflux (of any grade) for prevention of renal damage is recommended.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Management and Outcome of Vesicoureteral Reflux: A 14-Year Experience

Nassiri

Ghavami-Adel

2018

Iran J Pediatr

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“…This approach could be considered as an alternative to long-term prophylaxis. Arguments in favour of this approach include the high spontaneous cure rate of VUR, lack of reduction in renal complications associated with treatment, and the possibility that VUR may be caused by bladder dysfunction (treat the bladder instead) [Faust and Pohl, 2007;Hodson et al 2007]. In addition, the risks of bacterial resistance are lower than with long-term prophylaxis.…”

Section: Non-treatment (Short-term Antibiotics)mentioning

confidence: 99%

“…This can cause practical difficulties, particularly in developing countries where access to antibiotics is often limited. Cure of VUR is associated with a reduction in febrile UTI/pyelonephritis, [Hodson et al 2007] thereby decreasing overall morbidity. VUR persists for at least 510 years in many cases [Smellie et al 2001] (particularly high-grade reflux associated with scarred kidneys [Godley et al 2001]), placing susceptible kidneys at potential risk of progressive renal damage.…”

Section: Non-treatment (Short-term Antibiotics)mentioning

confidence: 99%

Endoscopic treatment of vesicoureteral reflux: current practice and the need for multifactorial assessment

Läckgren

Stenberg

2009

Therapeutic Advances in Urology

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Vesicoureteral reflux (VUR) affects around 1% of all children. It carries an increased risk of febrile urinary-tract infections (UTIs) and is associated with impaired renal function. Antibiotic prophylaxis is an established approach to managing the condition, but it does not protect against UTI and encourages bacterial resistance. Ureteral re-implantation (open surgery) is a relatively traumatic procedure typically requiring hospitalization, and there is a risk of significant post-treatment complications. Endoscopic treatment with NASHA/Dx gel (Deflux Õ ) is minimally invasive, well tolerated and provides cure rates approaching those of open surgery: 8090% in several studies. It has also been shown to be effective in a variety of 'complicated' cases. Thus, endoscopic treatment is generally preferable to open surgery and long-term antibiotic prophylaxis. Non-treatment of VUR is being discussed as an alternative option, although this mainly appears suitable for children with low-grade reflux and normal kidneys. A new approach to managing VUR may be considered, with treatment decisions based not only on the grade of reflux but also on factors such as age, sex, renal scarring and bladder dysfunction. Open surgery would be reserved only for use in the 1015% of children not responding to endoscopic treatment and those with severe ureteral anomalies.

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“…Certainly, RN can follow UTI, especially without prompt antibiotic treatment (10,11). Prospective studies comparing antireflux surgery with antibiotic prophylaxis fail to show significant differences in acquisition of kidney defects (12)(13)(14) or progression to ESRF (15). However, not all chronic radiologic kidney defects after UTIs are associated with VUR (16) and not all RN is pyelonephritic because some individuals born with VUR have malformed kidneys (17,18).…”

Section: Introductionmentioning

confidence: 99%

Primary, Nonsyndromic Vesicoureteric Reflux and Nephropathy in Sibling Pairs

Lambert

Stewart

Gullett³

et al. 2011

Clinical Journal of the American Society of Nephrology

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on behalf of the UK VUR Study GroupSummary Background and objectives Primary vesicoureteric reflux (VUR) can coexist with reflux nephropathy (RN) and impaired renal function. VUR appears to be an inherited condition and is reported in approximately one third of siblings of index cases. The objective was to establish a DNA collection and clinical database from U.K. families containing affected sibling pairs for future VUR genetics studies. The cohort's clinical characteristics have been described. Design, setting, participants, & measurementsMost patients were identified from tertiary pediatric nephrology centers; each family had an index case with cystography-proven primary, nonsyndromic VUR. Affected siblings had radiologically proven VUR and/or radiographically proven RN.Results One hundred eighty-nine index cases identified families with an additional 218 affected siblings. More than 90% were Ͻ20 years at the study's end. Blood was collected and leukocyte DNA extracted from all 407 patients and from 189 mothers and 183 fathers. Clinical presentation was established in 122; 92 had urinary tract infections and 16 had abnormal antenatal renal scans. RN was radiologically proven in 223 patients. Four patients had been transplanted; none were on dialysis. In 174 others aged Ͼ1 year, estimated GFR (eGFR) was calculated. Five had eGFR 15 to 59 and 48 had eGFR 60 to 89 ml/min per 1.73 m 2 . Values were lower in bilateral RN patients than in those with either unilateral or absent RN. ConclusionsThe large DNA collection from families with VUR and associated RN constitutes a resource for researchers exploring the most likely complex, genetic components predisposing to VUR and RN.

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Interventions for primary vesicoureteric reflux

Cited by 83 publications

References 44 publications

Management and Outcome of Vesicoureteral Reflux: A 14-Year Experience

Management and Outcome of Vesicoureteral Reflux: A 14-Year Experience

Endoscopic treatment of vesicoureteral reflux: current practice and the need for multifactorial assessment

Primary, Nonsyndromic Vesicoureteric Reflux and Nephropathy in Sibling Pairs

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