The Deflux Procedure Reduces the Incidence of Urinary Tract Infections in Patients with Vesicoureteral Reflux

Wadie, George; Tirabassi, Michael V.; Courtney, Richard; Moriarty, Kevin P.

doi:10.1089/lap.2006.0073

Cited by 40 publications

(37 citation statements)

References 43 publications

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“…This finding is similar to that of Wadie et al, who found an E coli UTI in 82% of a post-injection group. 15 In our study, febrile UTI developed in most children (55%) in their first year, after resolution of VUR. In their series, Elmore et al have reported that UTI developed within the first year after successful treatment in 83% of children in the Dx/HA group and 86% in the open surgery group.…”

Section: Discussionsupporting

confidence: 47%

“…It has been reported that female sex and bilateral VUR are risk factors for post-treatment UTI. 15 Sedberry-Ross et al stated that 9 of 12 children (75%) in the infection group had a history of dysfunctional elimination, and 9 of 12 children (75%) had multiple preoperative febrile UTIs. 9 The incidence of renal scarring was not statistically significant between the UTI and the no UTI group.…”

Section: Discussionmentioning

confidence: 99%

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Incidence of Febrile Urinary Tract Infections in Children after Successful Endoscopic Treatment of Vesicoureteral Reflux: A Long-Term Follow-Up

Hunziker

Mohanan

D’Asta

et al. 2012

The Journal of Pediatrics

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Objective To evaluate the incidence of febrile urinary tract infection (UTI) after successful endoscopic correction of intermediate and high-grade vesicoureteral reflux (VUR).Study design Medical records of 1271 consecutive children (male, 411; female, 903) who underwent successful endoscopic correction of VUR were reviewed. Factors potentially influencing postoperative UTIs, such as history of presentation, age, sex, grade of VUR, renal scarring, and agent used for the endoscopic injection, were analyzed.Results Febrile UTI developed in 73 children (5.7%) after successful endoscopic correction of VUR. Thirty-nine children had a single episode of UTI, and 34 children had two or more episodes at 1 month to 5.9 years (median, 1 year) after correction of VUR. With multivariate analysis, female sex (P < .001), history of preoperative bladder/ bowel dysfunction (BBD; P = .005), and BBD after endoscopic correction (P = .001) were revealed to be the most important independent risk factors for a febrile UTI after successful correction of VUR. ConclusionsThe incidence of febrile UTIs after successful correction of intermediate and high grade VUR is low.Female sex and BBD were the most important risk factors in the development of febrile UTI. Our data supports the importance of assessing bladder and bowel habits in older children with febrile UTIs after endoscopic correction of VUR. (J Pediatr 2012;-:---).V esicoureteral reflux (VUR) is the most common urinary tract abnormality in pediatrics, occurring in 1% to 2% of children, including 30% to 40% of children with urinary tract infection (UTI). 1,2 The association of VUR, febrile UTI, and renal parenchymal damage is well recognized. Reflux nephropathy is a cause of childhood hypertension and chronic renal failure. 3 Marra et al reviewed data on children with chronic renal failure who had high-grade VUR in the Italkid project, a database of Italian children with chronic renal failure, and found that those with VUR accounted for 26% of all children with chronic renal failure. The various treatment options currently available for VUR are: (1) long term antibiotic prophylaxis; (2) open surgical treatment; (3) minimally invasive endoscopic treatment; and (4) observation or intermittent therapy with management of bladder/bowel dysfunction (BBD) and treatment of UTI as they occur.Since United States Food and Drug administration approval in 2001 of dextranomer hyaluronic acid (Dx/HA) as a tissue augmenting substance for subureteral injection, endoscopic treatment has become a widely accepted minimally invasive alternative in the management of VUR.The main goals of treatment of children with VUR are to prevent renal parenchymal damage and morbidity associated with recurrent febrile UTIs. Relatively few studies have examined the incidence of febrile UTIs after successful resolution of VUR with endoscopic injection. The duration of follow-up in most series has been short, with conflicting rates of incidence of UTI. Febrile UTIs after successful resolution of VUR have been reported a...

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Section: Discussionsupporting

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Incidence of Febrile Urinary Tract Infections in Children after Successful Endoscopic Treatment of Vesicoureteral Reflux: A Long-Term Follow-Up

Hunziker

Mohanan

D’Asta

et al. 2012

The Journal of Pediatrics

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“…Although many studies suggest that appropriate selection of patients can lead to higher success rate, lower recurrence and complications, however biodegradable agents such as Dx/HA may cause VUR recurrence and failure during long-term follow up (25). The reported success rate is 70% for VUR correction using STING procedure in the literature (8,23). In the current study, the success rate for endoscopic correction of the VUR using Dx/HA injection was 93.3%, which provides a higher rate compared to the literature.…”

Section: Discussionmentioning

confidence: 99%

“…In the current study, the success rate for endoscopic correction of the VUR using Dx/HA injection was 93.3%, which provides a higher rate compared to the literature. However, in a study by Wadie et al, the overall success rate was reported 77.4% during single Dx/HA injection (8). Several studies evaluated poly-acrylate polyalcohol copolymer (PPC) as an effective and safe material in VUR correction instead of Dx/HA and its success rate has been reported more than 90% (28,29).…”

Section: Discussionmentioning

confidence: 99%

“…Three main therapy methods have been introduced for VUR treatment including observational therapy, prophylactic antibiotic administration, ureteroneocystostomy and endoscopic subureteral injection (1,6,7). Observational therapy emphasizes the spontaneous resolution of the VUR, however several studies showed incidence rate of approximately 15% in all children (8). In addition, some reports showed that prophylactic antibiotic not only cannot prevent pyelonephritis but also leads to UTI with antibiotic resistant organisms that make more challenging problems (9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic correction of vesicoureteral reflux in children

Rahimi¹,

Nazarbaghi²,

Valizadeh³

et al. 2018

J Renal Inj Prev

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Implication for health policy/practice/research/medical education:Dextranomer/hyaluronic acid subureteric injection provides acceptable resolution rate among vesicoureteral reflux (VUR) patients and this highlights the necessity for the strict implementation of it in VUR. Additionally patients underwent a one-year follow up period, subsequently. Follow up included urine analysis, urine cultures and kidney and urinary tract ultrasonography study. Results: Of a total 30 patients, 8 patients (27%) were male and 22 patients (73%) were female. The mean age of patients was 25.19 ± 0.70 months. Postoperative VUR resolution was observed in 28 patients (93.3%). Moreover, during one year follow up, urinary tract infection (UTI) was not reported in patients. However, recurrent VUR was detected in 8 patients (27%) during ultrasonography follow up. Analysis showed no significant difference of recurrence in VUR between males and females (P = 0.285) and VUR severity (P = 0.1). There was a significant relationship between recurrent UTI history before intervention and VUR recurrence after subureteric injection (P = 0.007). Conclusion: Dx/HA acid subureteric injection provides acceptable resolution rate among VUR patients, but its biodegradability causes VUR recurrence during one-year follow up. Please cite this paper as:

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Vesicoureteral Reflux

Snodgrass

Bush

2013

Pediatric Urology

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The Deflux Procedure Reduces the Incidence of Urinary Tract Infections in Patients with Vesicoureteral Reflux

Abstract: We conclude that the Deflux procedure is effective not only in eliminating VUR on radiologic studies, but also in reducing the incidence of UTIs and antibiotic use in children with VUR.

Cited by 40 publications

References 43 publications

Incidence of Febrile Urinary Tract Infections in Children after Successful Endoscopic Treatment of Vesicoureteral Reflux: A Long-Term Follow-Up

Incidence of Febrile Urinary Tract Infections in Children after Successful Endoscopic Treatment of Vesicoureteral Reflux: A Long-Term Follow-Up

Endoscopic correction of vesicoureteral reflux in children

Vesicoureteral Reflux

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