Role of prophylaxis in vesicoureteral reflux

Faust, William; Pohl, Hans G.

doi:10.1097/mou.0b013e3281ddb2db

Cited by 20 publications

(13 citation statements)

References 34 publications

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“…So it can prevent the ESRD. In one study, Faust writes "Recent studies have challenged the traditional paradigm of aggressive vesicoureteral reflux management with surgery or antibiotic prophylaxis" (10). Some studies have noted the lack of strong evidence on the effectiveness of prophylactic antibiotics or surgical interventions in improving outcomes and have suggested that well-designed genetic epidemiological studies may help better determine the predictive factors of this disease (11).…”

Section: Discussionmentioning

confidence: 99%

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%

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

Nassiri

Ghavami-Adel

2018

Iran J Pediatr

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“…[1] There are two types of cystography: traditional or VCUG and direct radioisotopes cystogram both required to catheterization, and VCUG is necessary for male children at the first investigation. [2345]…”

Section: Introductionmentioning

confidence: 99%

Use of sedative drugs at reducing the side effects of voiding cystourethrography in children

et al. 2017

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Background:Imaging of the kidneys and urinary tract has a significant and critical role for diagnosis of genitourinary system diseases. Although technological progress goes toward less invasive approaches, some of the current methods are still invasive and annoying. Voiding cystourethrography (VCUG) is the best and most accurate method for diagnosis and grading of vesicoureteral reflux. VCUG is a distressful procedure that gives serious anxiety and pain in a large proportion of children and fear for parents; therefore, using effective sedative drugs with the least side effects is necessary and should be considered.Materials and Methods:In this review article, importance and efficacy of different drugs before catheterization VCUG be compared in the base of literature survey on EMBASE, PubMed, and Cochrane source.Results:We found that the treatment should be based on nonpharmacological and pharmacological methods; nonpharmacological treatment includes the psychological preparation before procedures as a safety precaution with little or no risk modality, as well as reassuring support. The presence of parents during painful procedures cannot alleviate children distress. Pharmacological methods include oral midazolam (0.5 mg/kg) and intranasal use (0.2 mg/kg) that had been used 10 min before the procedure can effect on anterograde amnesia and sedation without considerable effect on accuracy and grade of reflux. Nitric oxide has a shorter recovery time versus midazolam but has a potential risk for deep sedation and may interfere with the child's voiding phase.Conclusion:In summary, oral midazolam of 0.5–0.6 mg/kg or 0.2 mg/kg intranasal is acceptable drug that can be used before VCUG.

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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%

“…Recently, the possibility of not actively treating VUR has been proposed, whereby antibiotic therapy is administered only when UTIs occur [Faust and Pohl, 2007]. This approach could be considered as an alternative to long-term prophylaxis.…”

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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Role of prophylaxis in vesicoureteral reflux

Abstract: Recent studies have challenged the traditional paradigm of aggressive vesicoureteral reflux management with surgery or antibiotic prophylaxis. In light of these findings, pediatric urologists will need to reexamine treatment modalities for vesicoureteral reflux.

Cited by 20 publications

References 34 publications

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

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

Use of sedative drugs at reducing the side effects of voiding cystourethrography in children

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

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