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Treatment of vesicoureteric reflux: results after 3 years in a prospective study
1Department of Pediatric Urology, Sophia Children's Hospital, Rotterdam, The Netherlands.
Insights
Antibiotic treatment is effective for mild vesicoureteric reflux (VUR) in children. For severe VUR (grades IV and V), surgery is recommended over conservative management to ensure successful outcomes.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Innovation
Background:
- Vesicoureteric reflux (VUR) is a common condition in children.
- Nonobstructive VUR requires effective management strategies to prevent complications.
- Determining optimal treatment based on reflux grade is crucial.
Purpose of the Study:
- To evaluate the efficacy of different treatment modalities for nonobstructive VUR in children.
- To compare conservative (antibiotic) versus surgical management based on VUR grade.
- To assess long-term outcomes after 3 years of follow-up.
Main Methods:
- Prospective study of 96 children (134 refluxing ureters) treated between 1982-1986.
- Follow-up of 94 children (130 refluxing ureters) for 3 years.
- Treatment allocation based on VUR grade: antibiotics for grade III or less, randomization for grade IV, reimplantation for grade V.
Main Results:
- Antibiotics alone resolved reflux in 52/84 ureters (grade I-III) and reduced it in 18.
- Reimplantation cured reflux in 39/49 ureters (grade V) without severe obstruction.
- Conservative management for grade IV reflux was less successful than surgery.
Conclusions:
- Conservative, nonsurgical treatment yields satisfactory results for grades I to III VUR.
- Surgery is the preferred treatment for grades IV and V VUR, excluding detrusor instability.
- Timely surgical intervention for higher-grade VUR ensures better outcomes and prevents complications.
Abstract:
Between 1982 and 1986, 96 children with nonobstructive vesicoureteric reflux were treated in a prospective study. There were 134 refluxing ureters. Results are reported after a follow-up period of 3 years in 94 children with 130 refluxing ureters. Initially all children with reflux grade III or less had antibiotic treatment only. Those with reflux grade IV were randomized for antibiotic treatment alone versus surgery plus antibiotic treatment, while the primary treatment of reflux grade V was reimplantation. In 84 ureters treated by antibiotics alone, reflux disappeared in 52 cases and in 18 ureters the reflux was reduced. In 49 ureters treated by reimplantation, reflux was cured in 39 cases and no severe ureteric obstruction was seen. Conservative management of reflux grade IV was less successful than surgery. The results of conservative, nonsurgical treatment of reflux grade I to III are satisfactory, but for grades IV and V reflux surgery should be the treatment of choice, provided that detrusor instability can be excluded.