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[Primary vesicoureteral reflux: report of 100 pediatric observations]
A Ayadi1, B Mahjoub, H Ben Hammouda
1Service de pédiatrie, CHU, T. Sfar Mahdia, Sousse, Tunisie.
Insights
Vesico-ureteral reflux (VUR) is common, often diagnosed via urinary infections (UI). Early antibiotic prophylaxis in children under 2 yields better outcomes, highlighting VUR
Area of Science:
- Pediatric Nephrology
- Urology
- Medical Imaging
Context:
- Vesico-ureteral reflux (VUR) is a significant condition in pediatric urology.
- Diagnosis often follows urinary tract infections (UTIs), particularly in young children.
- Understanding VUR prevalence and risk factors is crucial for effective management.
Purpose:
- To analyze 100 cases of primary VUR over seven years.
- To investigate the relationship between VUR, urinary infections, and potential renal damage.
- To evaluate the efficacy of different VUR treatment modalities.
Summary:
- A 7-year study of 100 primary VUR cases revealed higher incidence in females post-3 years old, with male predominance in infants.
- Urinary infection was the primary diagnostic indicator (87%).
- DMSA scintigraphy identified nephropathy in 24/38 patients, indicating risk of renal scarring. Antibiotic prophylaxis showed higher success rates in children under 2 years.
Impact:
- VUR is a common pediatric condition frequently detected through urinary infections.
- Early diagnosis and treatment, especially antibiotic prophylaxis in younger children, can improve outcomes.
- VUR management is critical to prevent long-term complications like nephropathy.
Abstract:
In this study, the authors have reported 100 cases of primary vesico-ureteral reflux (VUR) which occurred over a 7-year period. Patient age at presentation ranged from 1 month to 13 years, with a mean age of 3 years and 5 months. Overall, a higher rate of reflux was observed in the female population (63%) which was particularly evident after the age of 3 years, but with a male predominance during the first 12 months of life. In the majority of cases, the diagnosis of VUR was made following diagnosis and investigation of urinary infection (UI). A high level of UI was the most frequent sign of VUR (87% of cases), while in 6% of cases this disorder was diagnosed during the investigation of an uropathy which was found to be complex in all subjects. An analysis of 143 ureteral reflux units (URU) showed that VUR was pathological only in 17% of cases, and that the reflux grade was I, II, III and IV in 47.4, 28.14, 11.11 and 2.34% of cases respectively. DMSA scintigraphy in 38 patients showed signs of nephropathy in 24 cases, i.e., 14 scars and a decrease in kidney size in 9 cases, and an absence of fixation for one grade IV reflux. Forty subjects with 56 reflux units (34 grade I, II and 22 grade III, IV) were treated by antibiotic prophylaxis, with a positive outcome in 85% of cases in children under 2 years of age, compared to 40% for children aged over 2 years. Only 7 patients were treated by teflon endoscopic injection, and in one case a further injection was required; 21 patients with 30 reflux units were treated by surgery at a mean age of 4 years. In conclusion, VUR is a fairly common disorder, which is frequently detected via an IU; its potential gravity is associated with the risk of subsequent nephropathy.