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Resolution of vesicoureteral reflux during medical management in children
Insights
Medical management of primary vesicoureteral reflux (VUR) in children is effective, especially in younger patients and lower grades of reflux. Higher grades of VUR, particularly grade V, showed limited spontaneous resolution and increased complication risks.
Area of Science:
- Pediatric Urology
- Nephrology
- Medical Management
Background:
- Vesicoureteral reflux (VUR) is a common condition in infants and children.
- Medical management is a primary treatment approach for VUR.
- Understanding factors influencing VUR resolution is crucial for patient care.
Purpose of the Study:
- To evaluate the outcomes of non-surgical management for primary VUR in pediatric patients.
- To identify patient and reflux characteristics associated with spontaneous resolution and complications.
Main Methods:
- Retrospective chart review of 105 pediatric patients diagnosed with primary VUR.
- Analysis of patient demographics, reflux grade, and follow-up duration.
- Assessment of spontaneous resolution rates and complication incidence.
Main Results:
- Patient sex did not impact VUR outcomes.
- Younger age at diagnosis correlated with earlier and more frequent reflux resolution.
- Lower initial VUR grades (I-IV) demonstrated higher spontaneous resolution rates (92.3% for Grade I to 32.0% for Grade IV).
- Grade V VUR showed no spontaneous resolution and was associated with complications.
Conclusions:
- Medical management is effective for primary VUR, with younger age and lower reflux grades predicting better outcomes.
- Close monitoring is essential for higher-grade VUR (IV and V) due to limited resolution and higher complication risk.
- Renal scarring and secondary obstructive uropathy are significant potential complications of VUR.
Abstract:
A retrospective study was performed to evaluate the results of medical management of primary vesicoureteral reflux (VUR) in infants and children. The charts of 105 patients (74 boys, 31 girls) with 167 refluxing ureters were reviewed. The age at diagnosis ranged from 3 days to 9.2 years (mean 1.3 +/- 1.9 years). The mean duration of follow-up was 2.4 +/- 1.5 years. We found that the patient's sex did not influence the fate of VUR and its complications. Patients whose reflux improved while being managed medically were younger than those who did not improve, and the younger the patient the sooner the reflux resolved. Improvement and resolution of reflux were also related to grade, and the lower the initial grading the sooner the reflux resolved. Spontaneous resolution rates of reflux were 92.3%, 76.2%, 61.7%, and 32.0% for grades I, II, III, and IV, respectively. No ureters with grade V reflux resolved without complications. The most common complications in our series were renal scarring and secondary obstructive uropathy.