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.
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Gross GW, Lebowitz RL (1981) Infection does not cause reflux. Am J Roentgenol 137(5):929–932
Sargent MA (2000) What is the normal prevalence of vesicoureteral reflux? Pediatr Radiol 30(9):587–593
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
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
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
Goonasekera CDA, Dillon MJ (1999) Hypertension in reflux nephropathy. BJU Int 83:1–12
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
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
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
NAPRTCS (2008) North American Pediatric Renal Transplant Cooperative Study (NAPRTCS); Annual report 2008
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
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
Schulman SL, Quinn CK, Plachter N, Kodman-Jones C (1999) Comprehensive management of dysfunctional voiding. Pediatrics 103:E31
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
Dhillon HK (1998) Prenatally diagnosed hydronephrosis: the Great Ormond Street experience. Br J Urol 81:39–44
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
Agrawalla S, Pearce R, Goodman TR (2004) How to perform the perfect voiding cystourethrogram. Pediatr Radiol 34:114–119
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
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
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
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
Roebuck DJ, Howard RG, Metreweli C (1999) How sensitive is ultrasound in the detection of renal scars? Br J Radiol 72:345–348
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
Ransley PG, Risdon RA (1975) Renal papillary morphology and intrarenal reflux in the young pig. Urol Res 3:105–109
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
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
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
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
Sillén U (2008) Bladder dysfunction and vesicoureteral reflux. Adv Urol 2008:815472
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
Smellie J, Edwards D, Hunter N, Normand IC, Prescod N (1975) Vesico-ureteric reflux and renal scarring. Kidney Int Suppl 4:65–72
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
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
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
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
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
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
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
National Institute for Health and Clinical Excellence (NICE). Urinary tract infection in children: diagnosis, treatment and long-term management. Accessed June 2011
Sillen U, Brandstrom P, Jodal U et al (2010) The Swedish reflux trial in children: V. Bladder dysfunction. J Urol 184:298–304
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
Routh JC, Inman BA, Reinberg Y (2010) Dextranomer/hyaluronic acid for pediatric vesicoureteral reflux: systematic review. Pediatrics 125:1001–1009
Holmdahl G, Braandstrom P, Lackgren G et al (2010) The Swedish reflux trial in children: II. Vesicoureteral reflux outcome. J Urol 184:280–285
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
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
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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
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DOI: https://doi.org/10.1007/978-88-470-5693-0_12
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