Primary vesicoureteral reflux: review of current concepts

Garin, Eduardo H.; Campos, Alfonso; Homsy, Yves

doi:10.1007/s004670050448

Cited by 99 publications

(42 citation statements)

References 49 publications

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“…Some studies have questioned the efficacy of antibiotic prophylaxis in patients with recurrent UTI, 6,13 but to date, none have been conclusive. One meta-analysis review concluded that antibiotic prophylaxis "may not" prevent recurrent symptomatic UTI on children.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Beyond VUR and GU anomalies, some other risk factors have been found associated with recurrent UTI. 5,6 The standard treatment for UTI infection in primary VUR patients is antibiotic prophylaxis. Since VUR is the most common abnormality in children with UTI, to prevent recurrences, antibiotic prophylaxis is started immediately after UTI treatment is finished and continued until a voiding cystourethrogram (VCUG) excludes VUR.…”

Section: Introductionmentioning

confidence: 99%

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Childhood Recurrent Urinary Tract Infection in Southern Thailand

2012

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Introduction: Recurrent urinary tract infection (UTI) is one of the major health problems in children because of its high rate of occurrence. Objective: Our aim of the study was to evaluate the prevalence and determine risk factors of recurrent UTI in Thai children. Patients and Methods: The medical records of children aged less than 15 years diagnosed with UTI at the Department of Pediatrics, Songklanagarind Hospital were reviewed. Results: A total of 307 children (144 boys, 163 girls) were followed up for at least 1 year. Fifty-six children, 31 (19.0%) boys and 25 (17.4%) girls, developed at least one recurrence totaling 153 recurrent UTI episodes. The recurrence rate was not statistically different between the sexes (p ¼ 0.8). On multivariate analysis, genitourinary system (GU) anomalies, particularly vesicoureteral reflux (VUR), were the most significant risk factors. Children aged greater than 5 years had a slightly higher risk of recurrence, irrespective of gender. Comparison of organisms associated with recurrent UTI with those associated with first UTI showed that the prevalence of Escherichia coli decreased from 76.9% to 56.2% but was still the major causative agent. In contrast, the prevalence of Klebsiella pneumoniae and unusual or mixed organisms significantly increased from 7.8% to 15.0% and 6.2% to 16.3%, respectively. Conclusion: One-fifth of children who had UTI developed recurrence and the rates were similar for males and females. Independent risk factors for recurrent UTI were found to be at age of >5 years and underlying disease of either GU anomaly or VUR.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Childhood Recurrent Urinary Tract Infection in Southern Thailand

2012

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“…In spite of the notably conservative approach applied in group 2, this study reveals that the traditional concept of surgery as the therapy of choice to prevent kidney damage in patients with increased risk for unfavorable clinical course, high-grade VUR, and nephropathy at diagnosis [8][9][10][11] is, and still is for some health care professionals, the cause for the selection of surgery as the initial therapeutic option for these patients. It has been observed how, in spite of a trend towards conservative treatment in the pre-guideline era, patients with VUR IV-V and nephropathy at diagnosis tended to be excluded from the sequential treatment algorithm.…”

Section: Discussionmentioning

confidence: 82%

Impact of using an evidence-based clinical guideline for the management of primary vesicoureteral reflux in children

et al. 2017

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Objective: To analyze changes in the therapeutic approach at a tertiary care hospital following the implementation of a clinical guideline for the treatment of primary vesicoureteral reflux (VUR) in children. Population and methods: Retrospective study conducted in a cohort of patients with primary VUR aged 0-15 years at a tertiary care hospital. The therapeutic approach before and after the development of the clinical guideline (2008) was compared. Results: A total of 297 patients (49.8% boys, 50.2% girls) were included; their mean age at the time of diagnosis was 21.71 months. VUR grading was: VUR I-III 45.1%, VUR IV-V 54,9%; 124 were treated after the implementation of the clinical guideline (group 1), and 173, before (group 2). The mean follow-up period was 124.32 months. A conservative approach was the initial treatment in 70.3% of group 1 patients and 67.9% of group 2 patients. The number of surgeries remains constant (31.45% versus 31.79%), with an increase in the number of endoscopic surgeries (p < 0.005). The profile of patients has changed based on the application of the algorithm proposed by the guideline. Fewer surgeries were done in patients with VUR IV-V (82.32% versus 59.9%, p= 0.000) and there were fewer cases of kidney damage at diagnosis (49.4% versus 9.8%, p= 0.000). Conclusions:The implementation of the clinical guideline has favored an initially conservative approach in patients with severe grade VUR and nephropathy, for whom surgery was traditionally indicated initially. Using clinical guidelines favors a unanimous, evidencebased approach that reduces the performance of unnecessary invasive procedures.

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“…Reflux grading may still be considered relevant only whether lack of improvement or progression of VUR grade, in a patient otherwise asymptomatic, is considered an indication for surgery too. However, actual association among VUR degree, renal damage, and need for surgery remains controversial as well as the real need to treat persistent VUR [12,16]. Furthermore, with a routine use of PD-VUS, comparison would be done among multiple PD-VUSs, increasing consistency.…”

Section: Discussionmentioning

confidence: 99%