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[Anti-reflux surgery in infancy: contra]

Wolfgang Rösch1

  • 1Klinik für Kinderurologie in Kooperation mit der Universität Regensburg, KUNO-Kliniken Standort St. Hedwig, Regensburg.

Aktuelle Urologie
|December 5, 2019
PubMed

Insights

Vesicoureteral reflux (VUR) management in infants is debated. Endoscopic VUR treatment in infants is not routinely recommended due to high spontaneous resolution rates and immature bladder function, despite its feasibility.

Area of Science:

  • Pediatric Urology
  • Nephrology
  • Surgical Innovation

Background:

  • Vesicoureteral reflux (VUR) management in infants is controversial.
  • High spontaneous resolution rates (up to 45%) and immature bladder function characterize VUR in early life.
  • Renal hypo-/dysplasia in boys is a significant associated condition (up to 30%).

Purpose of the Study:

  • To evaluate the current controversial management of VUR in infants.
  • To assess the role of endoscopic treatment versus conservative management.
  • To analyze outcomes regarding urinary tract infections, renal scarring, and surgical risks.

Main Methods:

  • Review of recent literature on VUR management in infants.
  • Comparison of outcomes between endoscopic treatment and antibiotic prophylaxis.
  • Consideration of anesthesia, recurrence rates, and obstruction risks with surgical interventions.

Main Results:

  • Endoscopic treatment for VUR in infants shows no significant difference in preventing urinary tract infections or renal scarring compared to antibiotic prophylaxis.
  • Minimally invasive anti-reflux surgery is feasible in infants.
  • High spontaneous VUR resolution rates (up to 45%) occur within the first 12-15 months of life.

Conclusions:

  • Endoscopic VUR treatment should not be a routine intervention in infants.
  • The high rate of spontaneous resolution and immature bladder function in infants necessitate a cautious approach.
  • Management decisions must weigh potential benefits against risks like anesthesia and surgical complications.

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