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The management of vesicoureteric reflux in children
Insights
Conservative therapy is suitable for Grade I vesicoureteric reflux (VUR). However, higher grades (II and III) may worsen, necessitating early surgical intervention for better outcomes in pediatric VUR management.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Management
Background:
- Vesicoureteric reflux (VUR) affects pediatric patients, with conservative management often being the initial approach.
- The natural history of VUR can include progression of renal damage and worsening reflux grades, even without overt symptoms.
Purpose of the Study:
- To review the outcomes of conservative and surgical management in children with vesicoureteric reflux.
- To identify indicators for early surgical intervention in pediatric VUR.
Main Methods:
- Retrospective review of 170 children diagnosed with vesicoureteric reflux.
- Analysis of treatment outcomes based on reflux grade, cystourethroscopy findings, and imaging studies (excretion urography, micturating cystourethrography).
Main Results:
- Conservative therapy was used for Grade I reflux.
- Children with Grade II and III reflux treated conservatively showed progressive upper tract dilation and scarring.
- Reflux grade could worsen, and unilateral reflux sometimes became bilateral, irrespective of symptoms.
- Abnormal ureteric orifices on cystourethroscopy and ureteric dilatation on imaging indicated the need for surgery.
Conclusions:
- Early surgical intervention is indicated for Grade II and III vesicoureteric reflux, particularly with specific cystourethroscopic or imaging findings.
- Vesicoureteric reimplantation is an effective surgical treatment with a low complication rate for pediatric VUR.
Abstract:
One hundred and seventy children with vesicoureteric reflux have been reviewed. Conservative therapy was the treatment of choice in Grade I reflux. Children with Grade II and Grade II reflux treated conservatively developed progressive upper tract dilation and scarring. Unilateral reflux sometimes became bilateral. In addition, the grade of reflux could worsen in the absence of symptoms or overt infection. Cystourethroscopy was an important investigation as an aid to management: the findings of abnormal ureteric orifices in the presence of Grade II and Grade III reflux indicated early surgical treatment. Surgery was also indicated in the presence of ureteric dilatation on excretion urography aand/or micturating cystourography. Vesicouretic reimplantation gave excellent results with few complications.