[The conservative treatment of children with vesico-ureteral reflux]

Area of Science:

• Pediatric Urology
• Nephrology
• Pediatric Nephrology

Background:

• Vesicoureteral reflux (VUR) affects children, potentially leading to renal damage and recurrent infections.
• Understanding the relationship between VUR, bladder dysfunction, and renal health is crucial for effective management.
• Nonoperative treatment strategies are vital for managing VUR in pediatric populations.

Purpose of the Study:

• To evaluate the examination and nonoperative treatment outcomes for 120 children diagnosed with VUR.
• To analyze the correlation between VUR, bladder dysfunction (normoreflexia, hyperreflexia, hyporeflexia), and renal function.
• To determine the efficacy of various nonoperative treatment modalities for pediatric VUR.

Main Methods:

• Comprehensive examination including renal function tests (urography, renoscintigraphy), lower urinary tract evaluation (cystography, cystoscopy, urodynamics), and immunological studies.
• Classification of VUR patients into groups based on bladder reflexia (normo-, hyper-, hyporeflexia).
• Application of pharmacotherapy (belladonna, aceclidine), percutaneous bladder electrostimulation, and combined therapies.

Main Results:

• VUR associated with bladder dysfunction, particularly hyperreflexia and hyporeflexia, correlated with increased cystitis incidence.
• Renal dysfunction was observed even in the contralateral kidney in cases of unilateral VUR.
• A clear relationship was identified between the degree of renal dysfunction, ureteral motor activity, and bladder dysfunction.

Conclusions:

• Nonoperative management of VUR in children requires a comprehensive approach addressing bladder dysfunction and renal health.
• Pharmacotherapy and electrostimulation show promise in managing VUR-related complications.
• Further discussion on indications for nonoperative VUR treatment in children is warranted based on these findings.