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[Treatment of idiopathic vesico-ureteral reflux in children]
1Service de Chirurgie Viscérale Pédiatrique, Hôpital Trousseau, Paris.
Insights
Vesicoureteral reflux (VUR) in children can lead to kidney scarring. While some infants resolve VUR naturally, others require intervention to prevent pyelonephritis and preserve kidney function.
Area of Science:
- Pediatric Urology
- Nephrology
Context:
- Vesicoureteral reflux (VUR) is a primary cause of pyelonephritis in children.
- Renal parenchymal scars resulting from pyelonephritis are irreversible and can impede kidney growth.
Purpose:
- To outline treatment strategies for pediatric VUR aimed at preventing renal scarring.
- To compare the efficacy and risks of surgical versus endoscopic VUR correction.
Summary:
- VUR may spontaneously resolve in 50% of infants under 2 years old, with antiseptic treatment recommended during this period.
- For persistent VUR, surgical correction (e.g., Cohen's technique) offers high success rates (98%).
- Endoscopic Teflon injection for VUR has lower reliability and carries risks like distant dissemination, ureteric stenosis, and bladder stones, leading to its reduced use.
Impact:
- Effective management of VUR is crucial for preventing long-term kidney damage in children.
- Understanding treatment outcomes guides clinical decisions in pediatric urology.
- The findings highlight the importance of specific, prolonged treatment to preserve renal function.
Abstract:
Vesicoureteral reflux is the principal cause of pyelonephritis in children. Medical treatment is designed to prevent the development of renal parenchymal scars, as these lesions are irreversible and frequently interfere with growth of the kidney. Treatment must therefore be specific and sufficiently prolonged. In infants under the age of 2 years, reflux may resolve in 50% of cases as the ureterovesical junction develops. During this period, treatment consisting of alternating antiseptics should be proposed to prevent the development of pyelonephritis. In all other cases, reflux must be corrected. Two techniques can be proposed at the present time: surgery which gives 98% immediate and permanent good results, using Cohen's technique, and injection of Teflon, which is much less reliable, with risks of distant dissemination, particularly to the brain, and the possibility of developing ureteric stenosis and bladder stones. These problems have led many paediatric urologists to abandon endoscopic treatment.