Skip to main content

The Vesicoureteric Maze: The Reasons of Misunderstanding

  • Chapter
  • First Online:
  • 2085 Accesses

Abstract

Vesicoureteral reflux is the most common congenital urological anomaly in children, but remains one of the most controversial issues. VUR covers two different entities: reflux disease and reflux symptom. It has been associated with an increased risk of urinary tract infection and renal scarring. VUR is diagnosed mostly after or during follow-up for antenatal hydronephrosis. The place of the cystography is yet to be discussed. Management of VUR is controversial and includes antibioprophylaxis, surgical intervention, or surveillance. No evidence-based guidelines exist for appropriate treatment and follow-up.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Gross GW, Lebowitz RL (1981) Infection does not cause reflux. Am J Roentgenol 137(5):929–932

    Article  CAS  Google Scholar 

  2. Sargent MA (2000) What is the normal prevalence of vesicoureteral reflux? Pediatr Radiol 30(9):587–593

    Article  CAS  PubMed  Google Scholar 

  3. Shaikh N, Ewing AL, Bhatnagar S, Hoberman A (2000) Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics 126:1084–1091

    Article  Google Scholar 

  4. Sun HL, Wu KH, Chen SM, Chao YH, Ku MS, Hung TW, Liao PF, Lue KH, Sheu JN (2013) Role of procalcitonin in predicting dilating vesicoureteral reflux in young children hospitalized with a first febrile urinary tract infection. Pediatr Infect Dis J 32(9):348–354

    Article  Google Scholar 

  5. Yeung CK, Godley ML, Dhillon HK, Gordon I, Duffy PG, Ransley PG (1997) The characteristics of primary vesico-ureteric reflux in male and female infants with pre-natal hydronephrosis. Br J Urol 80(2):319–327

    Article  CAS  PubMed  Google Scholar 

  6. Goonasekera CDA, Dillon MJ (1999) Hypertension in reflux nephropathy. BJU Int 83:1–12

    Article  PubMed  Google Scholar 

  7. Chantler C, Carter JE, Bewick M, Counahan R, Cameron JS, Ogg CS, Williams DG, Winder E (1980) 10 years’ experience with regular haemodialysis and renal transplantation. Arch Dis Child 55:435–445

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Ardissino G, Dacco V, Testa S, Bonaudo R, Claris-Appiani A, Taioli E et al (2003) Epidemiology of chronic renal failure in children: data from the ItalKid project. Pediatrics 111:382–387

    Article  Google Scholar 

  9. Mathew TH (1987) Reflux nephropathy as a cause of end stage renal failure. In: Twelfth report of the Australian and new Zealand combined dialysis and transplant registry. Disney APS, Ed Australian Kidney Foundation, Woodville, pp 115–121

    Google Scholar 

  10. NAPRTCS (2008) North American Pediatric Renal Transplant Cooperative Study (NAPRTCS); Annual report 2008

    Google Scholar 

  11. Craig JC, Irwig LM, Knight JF, Roy LP (2000) Does treatment of vesicoureteric reflux in childhood prevent end-stage renal disease attributable to reflux nephropathy? Pediatrics 105(6):1236–1241

    Article  CAS  PubMed  Google Scholar 

  12. Yeung CK, Godley ML, Dhillon HK, Duffy PG, Ransley PG (1998) Urodynamic patterns in infants with normal lower urinary tracts or primary vesico-ureteric reflux. BJU 81:461–467

    Article  CAS  PubMed  Google Scholar 

  13. Schulman SL, Quinn CK, Plachter N, Kodman-Jones C (1999) Comprehensive management of dysfunctional voiding. Pediatrics 103:E31

    Article  CAS  PubMed  Google Scholar 

  14. Van Gool JD, Hjälmas K, Tamminen-Mobius T, Olbing H (1992) Historical clues to the complex of dysfunctional voiding, urinary tract infection and vesicoureteral reflux. The International Reflux Study in children. J Urol 148:1699–1702

    PubMed  Google Scholar 

  15. Dhillon HK (1998) Prenatally diagnosed hydronephrosis: the Great Ormond Street experience. Br J Urol 81:39–44

    Article  PubMed  Google Scholar 

  16. Hoberman A, Charron M, Hickey RW, Baskin M, Kearney DH, Wald ER (2003) Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med 348:195–202

    Article  PubMed  Google Scholar 

  17. Agrawalla S, Pearce R, Goodman TR (2004) How to perform the perfect voiding cystourethrogram. Pediatr Radiol 34:114–119

    Article  PubMed  Google Scholar 

  18. McLaren CJ, Simpson ET (2001) Direct comparison of radiology and nuclear medicine cystograms in young infants with vesico-ureteric reflux. BJU Int 87:93–97

    Article  CAS  PubMed  Google Scholar 

  19. Elison BS, Taylor D, Van der Wall H, Pereira JK, Cahill S, Rosenberg AR et al (1992) Comparison of DMSA scintigraphy with intravenous urography for the detection of renal scarring and its correlation with vesicoureteric reflux. Br J Urol 69:294–302

    Article  CAS  PubMed  Google Scholar 

  20. Foresman WH, Hulbert WC Jr, Rabinowitz R (2001) Does urinary tract ultrasonography at hospitalization for acute pyelonephritis predict vesicoureteral reflux? J Urol 165:2232–2234

    Article  CAS  PubMed  Google Scholar 

  21. Blane CE, DiPietro MA, Zerin JM, Sedman AB, Bloom DA (1993) Renal sonography is not a reliable screening examination for vesicoureteral reflux. J Urol 150:752–755

    CAS  PubMed  Google Scholar 

  22. Roebuck DJ, Howard RG, Metreweli C (1999) How sensitive is ultrasound in the detection of renal scars? Br J Radiol 72:345–348

    Article  CAS  PubMed  Google Scholar 

  23. Preda U, Jodal R, Sixt E, Stokland, Hansson S (2007) Normal dimercaptosuccinic acid scintigraphy makes voiding cystourethrography unnecessary after urinary tract infection. J Pediatr 151:581–584

    Article  PubMed  Google Scholar 

  24. Ransley PG, Risdon RA (1975) Renal papillary morphology and intrarenal reflux in the young pig. Urol Res 3:105–109

    CAS  PubMed  Google Scholar 

  25. Hansson S, Dhamey M, Sigstrom O et al (2004) Dimercapto-succinic acid scintigraphy instead of voiding cystourethrography for infants with urinary tract infection. J Urol 172:1071–1073

    Article  PubMed  Google Scholar 

  26. Herz D, Merguerian P, McQuiston L, Danielson C, Gheen M, Brenfleck L (2010) 5-year prospective results of dimercapto-succinic acid imaging in children with febrile urinary tract infection: proof that the top-down approach works. J Urol 184:1703–1709

    Article  PubMed  Google Scholar 

  27. Mantadakis E, Vouloumanou EK, Georgantzi GG, Tsalkidis A, Chatzimichael A, Falagas ME (2011) Acute Tc-99m DMSA scan for identifying dilating vesicoureteral reflux in children: a meta-analysis. Pediatrics 128:169–179

    Article  Google Scholar 

  28. Godley ML, Desai D, Yeung CK, Dhillon HK, Duffy PG, Ransley PG (2001) The relationship between early renal status, and the resolution of vesico-ureteric reflux and bladder function at 16 months. BJU Int 87(6):457–462

    Article  CAS  PubMed  Google Scholar 

  29. Sillén U (2008) Bladder dysfunction and vesicoureteral reflux. Adv Urol 2008:815472

    Google Scholar 

  30. Leroy S, Romanello C, Galetto-Lacour A et al (2007) Procalcitonin to reduce the number of unnecessary cystographies in children with a urinary tract infection: a European validation study. J Pediatr 150:89–95

    Article  CAS  PubMed  Google Scholar 

  31. Smellie J, Edwards D, Hunter N, Normand IC, Prescod N (1975) Vesico-ureteric reflux and renal scarring. Kidney Int Suppl 4:65–72

    Google Scholar 

  32. Smellie JM, Jodal U, Lax H, Mobius TT, Hirche H, Olbing H (2001) Outcome at 10 years of severe vesicoureteric reflux managed medically: report of the International Reflux Study in children. J Pediatr 139:656–663

    Article  CAS  PubMed  Google Scholar 

  33. Garin EH, Olavarria F, Garcia Nieto V, Valenciano B, Campos A, Young L (2006) Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study. Pediatrics 117:626–632

    Article  PubMed  Google Scholar 

  34. Pennesi MTL, Peratoner L, Bordugo A, Cattaneo A, Ronfani L, Minisini S, Ventura A (2008) Is antibiotic prophylaxis in children with vesicoureteral reflux effective in preventing pyelonephritis and renal scars? A randomized, controlled trial. Pediatrics 121:1489–1494

    Article  Google Scholar 

  35. Montini G, Rigon L, Zucchetta P et al (2008) Prophylaxis after first febrile urinary tract infection in children? A multicenter, randomized, controlled, noninferiority trial. Pediatrics 122:1064–1071

    Article  PubMed  Google Scholar 

  36. Craig JC, Simpson JM, Williams GJ et al (2009) Antibiotic prophylaxis and recurrent urinary tract infection in children. N Engl J Med 361:1748–1759

    Article  CAS  PubMed  Google Scholar 

  37. Brandstrom P, Esbjorner E, Herthelius M et al (2010) The Swedish reflux trial in children: I. Study design and study population characteristics. J Urol 184:274–279

    Article  PubMed  Google Scholar 

  38. Peters CA, Skoog SJ, Arant BS Jr et al (2010) Summary of the AUA guideline on management of primary vesicoureteral reflux in children. J Urol 184:1134–1144

    Article  PubMed  Google Scholar 

  39. National Institute for Health and Clinical Excellence (NICE). Urinary tract infection in children: diagnosis, treatment and long-term management. Accessed June 2011

    Google Scholar 

  40. Sillen U, Brandstrom P, Jodal U et al (2010) The Swedish reflux trial in children: V. Bladder dysfunction. J Urol 184:298–304

    Article  PubMed  Google Scholar 

  41. Elder JS, Diaz M, Caldamone AA et al (2006) Endoscopic therapy for vesicoureteral reflux: a meta-analysis. I. Reflux resolution and urinary tract infection. J Urol 175:716–722

    Article  PubMed  Google Scholar 

  42. Routh JC, Inman BA, Reinberg Y (2010) Dextranomer/hyaluronic acid for pediatric vesicoureteral reflux: systematic review. Pediatrics 125:1001–1009

    Article  Google Scholar 

  43. Holmdahl G, Braandstrom P, Lackgren G et al (2010) The Swedish reflux trial in children: II. Vesicoureteral reflux outcome. J Urol 184:280–285

    Article  PubMed  Google Scholar 

  44. Birmingham Reflux Study Group (1987) Prospective trial of operative versus non-operative treatment of severe vesicoureteric reflux in children: five years’ observation. Br Med J 295:237–241

    Article  Google Scholar 

  45. Wheeler D, Vimalachandra D, Hodson EM, Roy LP, Smith G, Craig JC (2003) Antibiotics and surgery for vesicoureteric reflux: a meta-analysis of randomised controlled trials. Arch Dis Child 88:688–694

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Delphine Demède .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag Italia

About this chapter

Cite this chapter

Demède, D., Mouriquand, P. (2015). The Vesicoureteric Maze: The Reasons of Misunderstanding. In: Lima, M., Manzoni, G. (eds) Pediatric Urology. Springer, Milano. https://doi.org/10.1007/978-88-470-5693-0_12

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-5693-0_12

  • Published:

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-5692-3

  • Online ISBN: 978-88-470-5693-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics