Surgical management of vesicoureteral reflux in children

Abstract

Vesicoureteral reflux (VUR) is the most common uropathy affecting children. Compared to children without VUR, those with VUR have a higher rate of pyelonephritis and renal scarring following urinary tract infection (UTI). Options for treatment include observation with or without antibiotic prophylaxis and surgical repair. Surgical intervention may be necessary in patients with persistent reflux, renal scarring, and recurrent or breakthrough febrile UTI. Both open and endoscopic approaches to reflux correction are successful and reduce the occurrence of febrile UTI. Estimated success rates of open and endoscopic reflux correction are 98.1% (95% CI 95.1, 99.1) and 83.0% (95% CI 69.1, 91.4), respectively. Factors that affect the success of endoscopic injection include pre-operative reflux grade and presence of functional or anatomic bladder abnormalities including voiding dysfunction and duplicated collecting systems. Few studies have evaluated the long-term outcomes of endoscopic injection, and with variable results. In patients treated endoscopically, recurrent febrile UTI occurred in 0–21%, new renal damage in 9–12%, and recurrent reflux in 17–47.6% of treated ureters with at least 1 year follow-up. These studies highlight the need for standardized outcome reporting and longer follow-up after endoscopic treatment.

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Abbreviations

VUR:

Vesicoureteral reflux

DX/HA = DHA:

Dextranomer/hyaluronic acid

UTI:

Urinary tract infection

UGS:

Urogenital sinus

UVJ:

Ureterovesical junction

VCUG:

Voiding cystourethrography

RNC:

Radionuclide cystogram

PTFE:

Polytetrafluoroethylene

STING:

Subureteric Teflon injection

HIT:

Hydrodistention implantation technique

DMSA:

99mTechnetium-dimercaptosuccinic acid

AUA:

American Urological Association

CAP:

Continuous antibiotic prophylaxis

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Correspondence to Steven Skoog.

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Answers

1. c

2. c

3. d

4. b

5. c

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Sung, J., Skoog, S. Surgical management of vesicoureteral reflux in children. Pediatr Nephrol 27, 551–561 (2012). https://doi.org/10.1007/s00467-011-1933-7

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Keywords

  • Vesicoureteral reflux
  • Endoscopy
  • Surgery
  • Laparoscopy
  • Uropathy