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Infection does not cause reflux
Insights
Vesicoureteric reflux (VUR) in children is not caused by urinary tract infections (UTIs). This study found VUR and UTIs are independent conditions that often occur together, suggesting VUR is a primary issue.
Area of Science:
- Pediatric Urology
- Nephrology
- Infectious Diseases
Background:
- Vesicoureteric reflux (VUR) was historically viewed as secondary to distal obstruction.
- More recently, urinary tract infection (UTI) has been hypothesized as a primary cause of VUR.
- Current understanding suggests most VUR cases are not associated with obstruction.
Purpose of the Study:
- To investigate the relationship between VUR and UTI in children.
- To determine if UTI is a causative factor for VUR.
- To analyze the independence of VUR and UTI as clinical variables.
Main Methods:
- Analysis of 601 voiding cystourethrograms (VCUGs) with simultaneous urine cultures in children over 12 months.
- Categorization of patients based on the presence or absence of VUR.
- Statistical comparison of UTI prevalence in children with and without VUR.
Main Results:
- Vesicoureteric reflux was present in 34% of children (204/601).
- Of children with VUR, 88% had sterile urine, indicating infection was not the cause.
- Prevalence of infection in children without VUR was similar (10%), suggesting independence.
Conclusions:
- The study data do not support the hypothesis that VUR is secondary to UTI in children.
- Vesicoureteric reflux and urinary tract infection appear to be independent variables that frequently coexist.
- Vesicoureteric reflux is concluded to be a primary phenomenon, likely due to ureterovesical junction incompetence.
Abstract:
Vesicoureteric reflux in children was originally considered to be a secondary phenomenon, caused by distal obstruction. We now know, however, that most children with vesicoureteric reflux are not obstructed. More recently, urinary tract infection has been thought to be the cause of most vesicoureteric reflux. To test this hypothesis, the results of 601 voiding cystourethrograms with simultaneous culture of the urine (in children), over a 12 month period were analyzed. Of the 34% (204/601) with vesicoureteric reflux, 88% (179/204) had sterile urine and 12% (25/204) were infected. Of the 66% (397/601) without reflux, 90% (357/397) had sterile and 10% (40/397) infected urine. These data do not support the concept that vesicoureteric reflux is secondary to infection in these children. On the contrary, it suggests that reflux and urinary tract infection are independent variables that often coexist. It is concluded that vesicoureteric reflux is a primary phenomenon and is due to incompetence of the ureterovesical junction.