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[The treatment procedure in vesicoureteral reflux in young children]
Insights
Nonoperative treatment is effective for mild vesicoureteral reflux (VUR) in children. However, severe VUR (Degrees III-V) requires prompt surgical intervention to prevent kidney damage and reflux-nephropathy.
Area of Science:
- Pediatric Nephrology
- Urology
Background:
- Vesicoureteral reflux (VUR) is a common condition in young children.
- Early diagnosis and management are crucial to prevent renal scarring and complications.
Purpose of the Study:
- To evaluate the efficacy of nonoperative treatment for different degrees of VUR in children.
- To determine the long-term outcomes and risk of reflux-nephropathy (RN) associated with VUR severity.
Main Methods:
- Analysis of 54 children diagnosed with VUR within the first three years of life.
- Classification of children into two groups based on VUR degree (I-II vs. III-V).
- Assessment of nonoperative treatment outcomes, including antibacterial therapy and management of lower urinary tract disorders, with follow-up urograms and evaluation for RN.
Main Results:
- Nonoperative treatment was effective in 75% of children with mild VUR (Degrees I-II).
- No significant renal parenchymal changes were observed in mild VUR cases, though some smaller kidneys were noted with prolonged duration.
- Children with severe VUR (Degrees III-V) showed signs of reflux-nephropathy (RN) during follow-up, ranging from Degree I to IV.
Conclusions:
- Nonoperative management is justified for children with mild VUR (Degrees I-II).
- Children with severe VUR (Degrees III-V) necessitate early surgical intervention to mitigate the risk of progressive renal damage and reflux-nephropathy.
Abstract:
A group of 54 children with vesicoureteral reflux recognized in the first 3 years of life was analysed. All of them received adequate nonoperative treatment including prolonged antibacterial therapy and management of cystitis and urodynamic disorders of the lower urinary tract. According to the degree of vesicoureteral reflux (VUR), the children were divided into two groups. Group 1 consisted of 29 children with Degrees I-II VUR in 37 ureters. Nonoperative treatment was effective in 75% of cases. Retrospective appraisal of urograms revealed no signs of cicatricial-sclerotic changes in the parenchyma of the kidneys. In five children with Degree II VUR of long duration the kidneys were smaller than the normal size of their age. Group 2 was made up of 24 patients with Degrees III-V VUR into 34 ureters. No changes were found in the renal parenchyma on urograms made during the first examination. During follow-up, however, signs of reflux-nephropathy (RN) were detected, which according to the recommendations of the International group for reflux study were evaluated as Degree I RN--10 cases, Degree II RN--12 cases, Degree III RN--8 cases, and Degree IV RN--4 cases. The authors believe nonoperative treatment of children with Degrees I-II VUR to be justified, patients with Degrees III-V VUR call for active surgical intervention from the moment that the reflux is recognized.