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Vesicoureteral reflux in boys
R M Decter1, D R Roth, E T Gonzales
1Scott Department of Urology, Baylor College of Medicine, Houston, Texas.
Insights
This study examined boys with primary vesicoureteral reflux (VUR). The findings suggest a modified management approach for VUR in boys is effective, with no observed renal damage in the observation group.
Area of Science:
- Pediatric Urology
- Nephrology
- Child Health
Background:
- Vesicoureteral reflux (VUR) is common in children, typically affecting more girls.
- Limited data exists on the specific presentation and natural history of VUR exclusively in boys.
Purpose of the Study:
- To characterize the presentation and clinical course of primary VUR in a cohort of 86 boys.
- To evaluate the outcomes of a modified management strategy for VUR in this male population.
Main Methods:
- Retrospective review of 86 boys diagnosed with primary VUR.
- Classification of patients into observation, chemoprophylaxis, or surgical treatment groups based on presentation and initial evaluation.
- Assessment of renal parenchymal status and surgical complication rates.
Main Results:
- 25% of boys presented before 3 months old, with younger infants showing more severe reflux.
- Urinary tract infection was the most common presentation, but 14% had dysfunctional voiding without infection.
- No renal parenchymal loss was observed in the observation group; surgical interventions had no serious complications.
Conclusions:
- A modified management approach for primary VUR in boys appears acceptable.
- Early presentation in boys is associated with more severe reflux.
- Further long-term follow-up is necessary to validate these findings.
Abstract:
The natural history of vesicoureteral reflux in children is well documented. In most series girls comprise the majority of the children followed. We reviewed the presentation and course of 86 boys with primary vesicoureteral reflux to define the nature of reflux in that selected population. Of the boys 25 per cent presented when they were less than 3 months old and the youngest tended to have the most severe reflux. Presentation was usually with urinary tract infection but 14 per cent had dysfunctional voiding symptoms without urinary tract infection. Based upon their presentation and initial evaluation the patients were allocated to 1 of 3 treatment protocols: observation, chemoprophylaxis or surgery. No renal parenchymal loss was detected in the boys on observation. Surgical therapy was free of serious complications. Over-all, this modified approach to the management of reflux in boys is acceptable although further followup will be required to confirm these initial conclusions.
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