Medical or surgical management for children with vesico‐ureteric reflux?

Jodal, Ulf; Hansson, Sverker; Hjälmås, K

doi:10.1111/j.1651-2227.1999.tb01319.x

Cited by 22 publications

(5 citation statements)

References 43 publications

(64 reference statements)

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“…There are two main approaches to the management of VUR: conservative and surgical. In all patients with secondary VUR, management of the underlying anomaly should be considered before treating the VUR (88,89).…”

Section: Management Of a Patient With Vurmentioning

confidence: 99%

Nuclear Medicine in Pediatric Nephro-Urology: An Overview

Mendichovszky

Solar

Smeulders

et al. 2017

Seminars in Nuclear Medicine

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In the context of ante-natally diagnosed hydronephrosis, the vast majority of children with a dilated renal pelvis do not need any surgical treatment, as the dilatation resolves spontaneously with time. Slow drainage demonstrated at Tc-99m-mercaptoacetyltriglycine (MAG3) renography does not necessarily mean obstruction. Obstruction is defined as resistance to urinary outflow with urinary stasis at the level of the pelvic-ureteric junction (PUJ) which, if left untreated, will damage the kidney. Unfortunately this definition is retrospective and not clinically helpful. Therefore, the identification of the kidney at risk of losing function in an asymptomatic patient is a major research goal. In the context of renovascular hypertension a DMSA scan can be useful before and after revascularisation procedures (angioplasty or surgery) to assess for gain in kidney function. Renal calculi are increasingly frequent in children. Whilst the vast majority of patients with renal stones do not need functional imaging, DMSA scans with SPECT and a low dose limited CT can be very helpful in the case of complex renal calculi. Congenital renal anomalies such as duplex kidneys, horseshoe kidneys, crossed-fused kidneys and multi-cystic dysplastic kidneys greatly benefit from functional imaging to identify regional parenchymal function, thus directing further management. Positron emission tomography (PET) is being actively tested in genito-urinary malignancies. Encouraging initial reports suggest that F-18-fluorodeoxyglucose (FDG) PET is more sensitive than CT in the assessment of lymph nodal metastases in patients with genito-urinary sarcomas; an increased sensitivity in comparison to isotope bone scans for skeletal metastatic disease has also been reported. Further evaluation is necessary, especially with the promising advent of PET/MRI scanners. Nuclear Medicine in paediatric nephro-urology has stood the test of time and is opening up to new exciting developments.

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Section: Management Of a Patient With Vurmentioning

confidence: 99%

Nuclear Medicine in Pediatric Nephro-Urology: An Overview

Mendichovszky

Solar

Smeulders

et al. 2017

Seminars in Nuclear Medicine

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“…[7][8][9][17][18][19][20][21][22] Guidelines regarding the management of primary VUR in children recommend that, for most children with VUR, initial treatment is comprised of continuous ABX prophylaxis until indication for surgery or spontaneous resolution of VUR. 16,[23][24][25] However, no specific guidelines are given with regards to the timing of follow-up VCUGs to detect VUR resolution.…”

mentioning

confidence: 99%

Timing of Follow-up Voiding Cystourethrogram in Children With Primary Vesicoureteral Reflux: Development and Application of a Clinical Algorithm

Thompson¹,

Simon

Sharma

et al. 2005

Pediatrics

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“…Since the majority of children will have resolution of VUR over time [89], most of them initially are treated with long-term antibiotic prophylaxis, and a periodic VCUG is performed until the spontaneous resolution of VUR [90]. However, no clear guidelines exist regarding the timing of follow-up by VCUGs.…”

Section: Timing Of Follow-up In Children With Vurmentioning

confidence: 99%

Imaging strategies for vesicoureteral reflux diagnosis

Stefanidis

Siomou

2007

Pediatr Nephrol

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The prevalence of vesicoureteral reflux (VUR), although reported to be low in the general population, is high in children with urinary tract infection (UTI), first degree relatives of patients with known VUR and children with antenatal hydronephrosis. In addition, it has been shown that VUR and UTIs are associated with renal scarring, predisposing to serious long-term complications, i.e., hypertension, chronic renal insufficiency and complications of pregnancy. Therefore, diagnostic imaging for the detection of VUR in the high-risk groups of children has been a standard practice. However, none of these associations has been validated with controlled studies, and recently the value of identifying VUR after a symptomatic UTI has been questioned. In addition, several studies have shown that renal damage may occur in the absence of VUR. On the other hand, some patients, mainly males, may have primary renal damage, associated with high-grade VUR, without UTI. Recently, increasing skepticism has been noted concerning how and for whom it is important to investigate for VUR. It has been suggested that the absence of renal lesions after the first UTI in children may rule out VUR of clinical significance and reinforces the redundancy of invasive diagnostic techniques. Therefore, the priority of imaging strategies should focus on early identification of renal lesions to prevent further deterioration.

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Medical or surgical management for children with vesico‐ureteric reflux?

Cited by 22 publications

References 43 publications

Nuclear Medicine in Pediatric Nephro-Urology: An Overview

Nuclear Medicine in Pediatric Nephro-Urology: An Overview

Timing of Follow-up Voiding Cystourethrogram in Children With Primary Vesicoureteral Reflux: Development and Application of a Clinical Algorithm

Imaging strategies for vesicoureteral reflux diagnosis

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