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Resolution rates of low grade vesicoureteral reflux stratified by patient age at presentation
1Department of Pediatric Urology, Children's Hospital, State University of New York, Buffalo School of Medicine, USA.
Insights
Age at presentation does not predict resolution of low-grade vesicoureteral reflux (VUR). Children under 10 have similar resolution rates to infants, suggesting prolonged antibiotic prophylaxis is often necessary.
Area of Science:
- Pediatric Urology
- Nephrology
- Medical Research
Background:
- Vesicoureteral reflux (VUR) is common in children, often managed with antibiotic prophylaxis.
- While overall VUR resolution rates are known, age-specific data for low grades are lacking.
Purpose of the Study:
- To determine if age at presentation influences the resolution rate of grades I to III primary vesicoureteral reflux.
- To identify age-based predictive factors for VUR resolution.
Main Methods:
- 168 boys and 433 girls with VUR were monitored from 1985-1993.
- Urine cultures and voiding cystourethrography were used to assess reflux.
- Patients were stratified into age groups: <1, 1-3, 4-6, 7-9, and 10+ years.
Main Results:
- No significant difference in resolution rates for grades I-III VUR was observed across different age groups.
- Children under 10 years showed similar resolution likelihoods to infants.
- Sex and laterality were not predictive of reflux resolution.
Conclusions:
- Low-grade VUR resolution may extend into adolescence.
- Age at presentation is not a reliable predictor of VUR resolution.
- Extended antibiotic prophylaxis is recommended for children with low-grade VUR unless surgical correction is pursued.
Purpose:
Most children with grades I to III primary vesicoureteral reflux are monitored for years on antibiotic prophylaxis until reflux resolves. While the overall resolution rate of these grades is known, the rates for various patient ages at presentation are unknown. Therefore, we examined resolution rates of these grades for different ages at presentation.
Materials And Methods:
From 1985 through 1990, 168 boys (245 ureters) and 433 girls (590 ureters) with all grades of reflux were enrolled in the study and monitored through the end of 1993. Urine cultures were obtained every 4 months and contrast voiding cystourethrography was repeated every 18 months. Age at presentation was stratified into groups younger than 1, 1 to 3, 4 to 6, 7 to 9, and 10 years and older. Resolution rates were then calculated for grades I to III reflux for each age at presentation. Time to resolution was also evaluated for each age and grade.
Results:
There were no significant differences between rates of resolution at different ages for each grade. Children less than 10 years old had as high a likelihood of resolution as infants. Neither sex nor bilaterality versus unilaterality was a helpful predictor of resolution. Time to resolution varied widely and it was also not helpful for identifying the cases of reflux that resolved.
Conclusions:
Low grade vesicoureteral reflux may not resolve until adolescence and age at presentation is not a reliable predictive factor. Children should remain on prophylaxis for many years unless definitive correction is undertaken.