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Vesico-ureteric reflux (VUR) in children often presents with urinary tract infections and is diagnosed late. While surgery is effective, conservative management can lead to spontaneous resolution over time.
Area of Science:
- Pediatric Nephrology
- Urology
Background:
- Vesico-ureteric reflux (VUR) is a common condition in children, often presenting with recurrent urinary tract infections (UTIs).
- Delayed diagnosis of VUR is frequent, with many children experiencing symptoms for years before diagnosis, potentially impacting long-term renal health.
- Long-term complications such as hypertension and renal insufficiency are observed in a significant minority of affected children.
Purpose of the Study:
- To analyze the clinical presentation, diagnostic delay, and outcomes of surgical and conservative management in a cohort of children with VUR.
- To evaluate the efficacy of different treatment strategies in resolving VUR and preventing complications.
- To investigate factors influencing spontaneous resolution of VUR.
Main Methods:
- Retrospective analysis of 262 children diagnosed with VUR.
- Categorization of treatment into surgical intervention and conservative management based on defined criteria.
- Monitoring of VUR resolution, recurrence of UTIs, and development of complications like hypertension and renal insufficiency.
Main Results:
- The majority of children presented with UTIs, predominantly in the pre-school years, but diagnosis was often delayed until school age.
- Surgical treatment achieved a 96.3% success rate in eliminating reflux, with minimal postoperative complications.
- Spontaneous resolution of VUR occurred in two-thirds of conservatively treated children, though it often took over 3 years. Recurrence of infection was noted in both treatment groups.
Conclusions:
- Early diagnosis and intervention for VUR are crucial to mitigate long-term renal damage.
- Both surgical and conservative approaches can be effective, with conservative management showing a high rate of spontaneous resolution over time.
- The study highlights the importance of long-term follow-up for children with VUR, regardless of initial treatment modality.
Abstract:
A series of 262 children suffering from vesico-ureteric reflux is presented. Nearly all presented with a urinary tract infection and the age at onset of symptoms was predominantly in the pre-school years. The reflux was not diagnosed in the majority until after the children started attending school. Over one-third had symptoms for more than half their lives before reflux was diagnosed. The incidence of hypertension and renal insufficiency in the series were 4% and 7-8% respectively. Nearly 60% of the children were selected by defined criteria for operation as their initial treatment. The remainder were treated conservatively in the first instance but 30% of these subsequently required operation. Reflux was eliminated in 96.3% of the children at the first operation and 5.5% developed postoperative ureteric dilatation, none of them permanently. Reflux disappeared spontaneously in two-thirds of the children treated conservatively but took more than 3 years in 46%. Infection recurred in 24% of children treated by operation and in 29% treated conservatively. The incidence with which reflux disappeared spontaneously in the children treated conservatively was related to time, not to the infection recurrence rate.