Therapeutic Management of Children with Vesicoureteral Reflux

Area of Science:

• Pediatric Urology
• Nephrology
• Infectious Diseases

Background:

• Vesicoureteral reflux (VUR) management in children involves surgical intervention or continuous antibiotic prophylaxis (CAP).
• Contrasting data exist regarding the long-term effectiveness and complications of these VUR therapies.
• Evaluating recurrence of febrile urinary tract infections (UTIs) and VUR resolution is crucial for treatment assessment.

Purpose of the Study:

• To compare the effectiveness of surgical treatment versus CAP for pediatric VUR.
• To analyze the recurrence rates of febrile UTIs and VUR resolution post-treatment.
• To identify predictors of treatment success or failure in children with VUR.

Main Methods:

• A cohort of 350 pediatric patients with VUR was studied.
• Diagnosis of VUR was confirmed using contrast-enhanced voiding urosonography (ceVUS); renal scintigraphy assessed kidney scarring.
• Outcomes including VUR recurrence, febrile UTIs, and reflux-related nephropathy were analyzed after 12 months.

Main Results:

• Surgery led to recurrent febrile UTIs in 27 children, particularly those with VUR grades III and V. Thirteen surgical patients developed scars and chronic renal failure.
• CAP treatment resulted in persistent febrile UTIs in 30% of 140 patients. Fifty-two of 95 re-evaluated patients had persistent VUR, all with severe grades.
• CAP therapy demonstrated superior prevention of renal scarring compared to surgery, especially in higher VUR grades. Late-onset or neonatal VUR showed limited reversibility.

Conclusions:

• Continuous antibiotic prophylaxis (CAP) may be more effective than surgery in preventing renal scarring in pediatric VUR, particularly for higher grades.
• Surgical intervention for VUR can be associated with higher rates of recurrent UTIs and renal scarring.
• This study provides prognostic information by identifying predictors for successful or failed VUR treatments, aiding clinical decision-making.