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Character of urinary tract infections and pyelonephritic renal scarring after antireflux surgery
Insights
Antireflux surgery reduced severe pyelonephritis (kidney infection) in girls but did not prevent renal scarring. The study followed girls who had Politano-Leadbetter antireflux surgery and matched controls.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Renal Health
Background:
- Urinary tract infections (UTIs) are common in children.
- Vesicoureteral reflux (VUR) increases UTI risk and can lead to kidney damage.
- Antireflux surgery aims to correct VUR and prevent recurrent UTIs and renal scarring.
Purpose of the Study:
- To evaluate the long-term efficacy of Politano-Leadbetter antireflux surgery in girls.
- To assess the impact of surgery on the incidence of different UTI grades and renal scarring.
Main Methods:
- Prospective follow-up of 40 girls undergoing Politano-Leadbetter antireflux surgery (mean age 5.2 years).
- Matched control group for comparison.
- Detailed matching criteria including age at UTI onset, VUR grade, and UTI severity.
- Identical follow-up duration for both groups.
Main Results:
- Significantly fewer high-grade pyelonephritic UTIs (grade 3) in the operated group (9 vs. 29 episodes).
- Similar incidence of symptomatic lower UTIs (grade 2) between operated and non-operated groups (14 vs. 19 episodes).
- Higher incidence of asymptomatic bacteriuria in the operated group (26 vs. 12 episodes).
- Antireflux surgery did not prevent the progression of pyelonephritic renal scarring in either group.
Conclusions:
- Politano-Leadbetter antireflux surgery effectively reduces severe pyelonephritis episodes in girls with VUR.
- The surgery does not prevent the progression of renal scarring.
- Further research is needed to understand the long-term implications of asymptomatic bacteriuria post-surgery.
Abstract:
We followed 40 girls who had undergone antireflux surgery (the Politano-Leadbetter technique) at the mean age of 5.2 years until they reached a mean age of 9.5 years. Each girl was matched with a control. The pairs were matched for age at the onset of urinary tract infections and time of operation or selection, number as well as grade (1 to 3) of severity of the preoperative episodes and grade (II to IV) of reflux. Followup time for each member of the pair was identical. Postoperatively, the incidence of pyelonephritic urinary tract infection episodes (grade 3) was significantly less (p less than 0.01) among the operated than the nonoperated cases (9 versus 29), while the number of symptomatic lower urinary tract infections (grade 2) was virtually the same (14 versus 19) in both groups. The operated cases had more asymptomatic bacteriuria (26 versus 12 episodes) so that the total numbers of episodes of bacteriuria (grades 1 through 3) were similar in both groups. Antireflux surgery did not prevent the progression of pyelonephritic renal scarring, which continued equally in operated and nonoperated cases.