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[Vesico-ureteral reflux: diagnostic and therapeutic procedures]
N Vendemmia1, A Colella, M Vendemmia
1Divisione di Pediatria e Neonatologia, Ospedale San G. Moscati, Aversa, Italia.
Summary
Vesicoureteral reflux (VUR), linked to urinary tract infections (UTIs), requires careful diagnosis to prevent kidney damage. This study suggests a method to select infants for further testing, reducing unnecessary X-ray exposure.
Area of Science:
- Pediatric Urology
- Nephrology
- Diagnostic Imaging
Background:
- Vesicoureteral reflux (VUR) is a common uropathy associated with urinary tract infections (UTIs).
- Early identification of VUR is crucial to prevent reflux nephropathy and its complications.
- Minimizing radiation exposure in infants is a significant clinical consideration.
Purpose of the Study:
- To propose a patient selection strategy for diagnosing VUR, aiming to reduce unnecessary X-ray exposure.
- To identify infants who would benefit most from further diagnostic imaging like cystourethrography.
- To establish criteria for selecting infants for VUR diagnosis, focusing on clinical and imaging findings.
Main Methods:
- Patient selection based on distal ureteral dilatation and time from UTI symptoms to fever.
- Initial diagnosis of pyelonephritis is essential.
- Utilizing ultrasound and DMSA radionuclide scintigraphy to guide the need for cystourethrography.
Main Results:
- A selective approach for cystourethrography can minimize radiation exposure in infants with suspected VUR.
- Ultrasound and DMSA scintigraphy aid in identifying infants requiring further investigation.
- The proposed selection criteria help target diagnostic resources effectively.
Conclusions:
- Implementing a selective diagnostic pathway for VUR can reduce unnecessary radiation exposure in infants.
- Early and accurate diagnosis of VUR is key to preventing long-term renal complications.
- Antibiotic prophylaxis is recommended for infants diagnosed with VUR, with duration tailored to VUR grade and patient age.