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[Vesicoureteral reflux: diagnosis and management in children]
Jiad N Mcheik1, Guillaume Levard
1Service de Chirurgie Pédiatrique, Centre Hospitalo-Universitaire de Poitiers, 350, avenue Jacques Coeur, BP 577, 86021 Poitiers, France. jiadmcheik@yahoo.fr
Insights
Acute pyelonephritis is the primary way to discover vesicoureteric reflux (VUR) in children. Antenatal screening also identifies VUR, but treatment depends on various factors like age, sex, and reflux grade.
Area of Science:
- Pediatric Urology
- Nephrology
- Diagnostic Imaging
Context:
- Vesicoureteric reflux (VUR) is the most common congenital uropathy in children.
- Early detection and management are crucial for preventing renal damage.
- Antenatal diagnosis plays a role, but acute pyelonephritis remains a key diagnostic context.
Purpose:
- To evaluate the role of antenatal diagnosis in detecting and managing pediatric vesicoureteric reflux.
- To analyze the diagnostic modalities, reflux characteristics, and treatment outcomes in children with VUR.
- To determine the effectiveness of current diagnostic and management strategies for VUR.
Summary:
- A retrospective study reviewed 180 children with VUR, diagnosed via retrograde cystography.
- Acute pyelonephritis was the most common diagnosis context (77%), followed by antenatal screening (16%).
- Reflux characteristics varied, with 66% being less than grade II, but antenatal diagnoses often showed higher grades (62%). Both surgical and medical treatments were employed, with similar low rates of recurrent pyelonephritis.
Impact:
- Highlights the continued importance of diagnosing VUR following acute pyelonephritis.
- Suggests renal ultrasonography and retrograde cystography are valuable post-infection diagnostic tools.
- Emphasizes that VUR management is multifactorial, influenced by patient-specific and environmental factors.
Objective:
Based on a retrospective study of children followed for vesicoureteric reflux, the authors evaluated the role of antenatal diagnosis in the detection and global management of the most frequent uropathy observed in children.
Materials And Methods:
The case files of 180 children followed for reflux over a 4-year period were reviewed. The diagnosis of reflux was based on retrograde cystography. The authors tried to define the main indications for the renal and urinary tract assessment and defined the grade and type of reflux, as well as the therapeutic indications and results. 180 children (105 girls and 75 boys) with vesicoureteric reflux were observed during the study period. The mean age at the time of diagnosis was 26.75 months.
Results:
Vesicoureteric reflux was usually diagnosed in a context of acute pyelonephritis in 139 children (77%);, at the time of the first episode in 84% of cases. Antenatal diagnosis of reflux during screening for dilated renal pelvis was the second most frequent modality (29 children, 16% of cases). The reflux involved a single urinary tract in 163 children and a duplicated tract in 17 children. Reflux was bilateral in 43% of cases. Reflux was less than grade II in 66% of cases, but an inverse proportion was observed in the case of antenatal diagnosis (62%). 55% of cases were treated surgically and 45% were treated medically. Follow-up of the children showed a low recurrent pyelonephritis rate that was similar in the two groups.
Conclusion:
Acute pyelonephritis remains the leading mode of discovery of vesicoureteric reflux and renal ultrasonography combined with retrograde cystography after a first episode of renal infection is therefore recommended. Antenatal screening may also reveal vesicoureteric reflux. It is difficult to summarize the therapeutic indications for reflux, as the treatment of vesicoureteric reflux is related to the child's age and sex, the grade of reflux, the clinical repercussions of the reflux and certain environmental factors, such as the family and social status.
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