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Surgical intervention in children with vesicoureteric reflux: are we intervening too late?

Basem A Khalil1, Anju Goyal, Alan P Dickson

  • 1Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, M27 4HA, UK.

Pediatric Surgery International
|June 1, 2010
PubMed

Insights

Many children with vesicoureteric reflux (VUR) experience kidney damage before surgery. A significant portion also shows worsening renal function during medical treatment, highlighting the need for timely intervention.

Area of Science:

  • Pediatric Urology
  • Nephrology
  • Surgical Intervention

Background:

  • Vesicoureteric reflux (VUR) is commonly managed medically to prevent kidney damage.
  • Surgical intervention is reserved for cases where medical management fails.
  • Assessing pre-surgical kidney damage is crucial for understanding VUR progression.

Purpose of the Study:

  • To investigate the extent of kidney damage in children with VUR before surgical intervention.
  • To determine if kidney function deteriorates during medical management of VUR.

Main Methods:

  • Retrospective review of pediatric patients undergoing ureteric re-implantation for VUR over 5 years.
  • Analysis of demographic data, radiological findings (DMSA scans), and renal function.
  • Definition of kidney damage included DMSA scarring and/or renal function below 45%.

Main Results:

  • 58% of kidneys showed reduced function prior to medical treatment.
  • 36% of kidneys experienced functional deterioration during medical management, often linked to UTIs.
  • 83% of patients had DMSA-documented kidney scarring before surgery.

Conclusions:

  • Significant kidney damage is present in over half of VUR patients needing surgery, even before treatment begins.
  • Progressive renal function decline affects one-third of patients during medical management.
  • Early referral and selective early surgical intervention may mitigate VUR-related renal damage in children.
Abstract

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