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Treatment of vesicoureteric reflux. Preliminary report of a prospective study
R J Scholtmeijer1, D J Griffiths
1Department of Paediatric Urology, Sophia Children's Hospital, Rotterdam, The Netherlands.
Insights
Antibiotic treatment is effective for mild (grade I-III) pediatric vesicoureteric reflux. Surgery is recommended for severe reflux (grade IV-V) to ensure cure and prevent complications.
Area of Science:
- Pediatric Urology
- Nephrology
Background:
- Vesicoureteric reflux (VUR) is a common condition in children.
- Non-obstructive VUR requires effective management to prevent renal scarring and damage.
Purpose of the Study:
- To evaluate the efficacy of different treatment strategies for non-obstructive VUR in children.
- To compare conservative (antibiotic) versus surgical management based on VUR grade.
Main Methods:
- Prospective study of 94 children with 137 refluxing ureters, followed for at least 18 months.
- Children with grade III or less VUR received antibiotics. Grade IV VUR was randomized between antibiotics alone or surgery plus antibiotics. Grade V VUR underwent reimplantation.
Main Results:
- Antibiotic therapy alone resolved reflux in 49/91 ureters (grade I-III) and reduced grade in 20.
- Reimplantation surgery cured reflux in 40/46 ureters (grade V) without severe obstruction.
- Conservative management for grade IV VUR showed lower success rates compared to surgery.
Conclusions:
- Antibiotic treatment is satisfactory for low-grade VUR (I-III).
- Surgery (reimplantation) is the preferred treatment for high-grade VUR (IV-V) to ensure resolution, provided detrusor instability is absent.
Abstract:
Between 1982 and 1986 95 children with non-obstructive vesicoureteric reflux were treated in a prospective study. Preliminary results are reported on 94 children with 137 refluxing ureters and a follow-up period of at least 18 months. All children with reflux grade III or less had antibiotic treatment only. Those with reflux grade IV were randomised for antibiotic treatment alone versus surgery plus antibiotic treatment, while the primary treatment of reflux grade V was reimplantation. In 91 ureters treated by antibiotics alone, reflux disappeared in 49 cases; in 20 cases the grade of reflux was reduced. In 46 ureters treated by reimplantation, reflux was cured in 40 cases and no severe ureteric obstruction was seen. Conservative management of reflux grade IV seems to be less successful than surgery. The results of conservative, non-surgical treatment of reflux grade I to III are satisfactory, but for grades IV and V reflux surgery seems to be the treatment of choice if detrusor instability can be excluded.