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Published on: January 7, 2019
Early management and long-term outcomes in primary vesico-ureteric reflux
1Birmingham Children's Hospital - Urology, Birmingham, UK. robcole900@gmail.com
Insights
Management of childhood vesicoureteric reflux (VUR) remains controversial. This review examines evidence for early management and long-term outcomes, focusing on implications for adult health.
Area of Science:
- Pediatric Urology
- Nephrology
Background:
- Childhood vesicoureteric reflux (VUR) is common, linked to bladder dysfunction and urinary tract infections.
- Pathogenesis increasingly involves lower urinary tract functional abnormalities.
- Long-term complications include reflux nephropathy, hypertension, and pregnancy issues.
Purpose of the Study:
- To review evidence for early management of primary VUR in children.
- To analyze the long-term outcomes of VUR into adulthood.
- To inform current management strategies based on evolving understanding.
Main Methods:
- Systematic review of existing literature on VUR management.
- Analysis of studies focusing on early intervention and long-term sequelae.
- Evaluation of evidence regarding surgical vs. conservative approaches.
Main Results:
- Surgical correction may reduce upper tract risks but may not address lower tract morbidity.
- Spontaneous resolution occurs in many cases.
- Incomplete management can lead to significant adult complications.
Conclusions:
- Management of childhood VUR requires careful consideration of both short-term and long-term consequences.
- Focus on lower urinary tract function is crucial for effective VUR management.
- Evidence supports a nuanced approach to optimize adult health outcomes.
Abstract:
What's known on the subject? and What does the study add? Despite evolving understanding of pathogenesis and natural history, controversy exists regarding management of childhood vesicoureteric reflux. Surgical correction of the reflux itself may reduce risk of upper tract complications in some but may not in itself constitute appropriate management of lower tract morbidity in many. This review examines the evidence for early management and long term outcomes in primary vesicoureteric reflux. Primary vesico-ureteric reflux is a common condition in childhood associated with bladder dysfunction and an increased risk of urinary tract infection. Recent evidence indicates a lower tract functional abnormality in its pathogenesis. Whilst spontaneous resolution will occur in many, some patients will go on to develop complications in adulthood including reflux nephropathy, hypertension, urinary tract infection, bladder dysfunction and complications of pregnancy. An evolving understanding of the natural history has seen radical changes in management. Evidence for management of the child with primary vesico-ureteric reflux is reviewed with a focus on the implications on long-term outcomes in adulthood.
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