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The role of vesicoureteral reflux in paediatric urinary-tract infection
Insights
Antireflux surgery for pediatric vesicoureteral reflux (VUR) can cure reflux in higher grades (III-IV). However, surgery does not significantly impact the incidence of recurrent urinary tract infections (UTI) in children.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Innovation
Background:
- Recurrent urinary tract infections (UTI) in children are often associated with vesicoureteral reflux (VUR).
- VUR is a condition where urine flows backward from the bladder to the ureters, increasing UTI risk.
- Surgical correction aims to prevent reflux and subsequent infections.
Purpose of the Study:
- To evaluate the efficacy of the Politano-Leadbetter operation in correcting VUR in children.
- To determine if antireflux surgery impacts the incidence of recurrent UTIs in pediatric patients.
- To compare surgical versus non-surgical management of VUR in relation to UTI frequency.
Main Methods:
- Retrospective analysis of 284 children (68 boys, 216 girls) with VUR (grades II, III, IV).
- Surgical correction (Politano-Leadbetter operation) performed in 49 children.
- Matched-pair analysis of 40 girls comparing surgical and non-surgical VUR management.
Main Results:
- Surgical correction showed a significantly higher cure rate (cessation of reflux) for VUR grades III and IV compared to non-surgical management.
- The overall incidence of UTI episodes tended to decrease with age, irrespective of treatment.
- Matched-pair analysis revealed no significant difference in UTI frequency between surgically treated and non-surgically treated children.
Conclusions:
- While Politano-Leadbetter surgery effectively corrects higher grades of VUR, it does not appear to reduce the frequency of subsequent UTIs in children.
- Spontaneous resolution of VUR occurs, but surgical intervention offers a more rapid and frequent cessation of reflux for significant grades.
- The study suggests focusing on VUR cessation rather than solely on UTI incidence reduction when considering surgical intervention.
Abstract:
Observations are reported from a series of 284 children, 68 boys and 216 girls, who had had one or more episodes of urinary tract infection (UTI) and had vesicoureteral reflux (VUR) of grade II, III or VI. In 6 of the boys and 43 of the girls the Politano-Leadbetter operation for correction of VUR was performed. Only in grade III or IV VUR was the cure rate--considered solely as cessation of reflux--significantly higher in surgically than in non-surgically treated children. Irrespective of sex or mode of treatment, the number of episodes of UTI tended to diminish as the children grew older. For more precise comparisons, two individually matched groups of 40 girls were studied. One girl in each pair was operated on. Within these matched pairs, the frequency of UTI episodes according to age did not differ appreciably. Nor did the number of UTI episodes before and after the time of operation differ significantly when analysis was made according to grade of reflux. Thus, although disappearance of surgically treated grades III and IV VUR was more rapid and more frequent than spontaneous cessation of reflux, the observations in the matched pair series indicated that antireflux surgery does not affect the incidence of UTI.