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Disappearance of vesicoureteral reflux in children
M Wennerström1, S Hansson, U Jodal
1Department of Pediatrics, Sahlgrenska University Hospital, Göteborg, Sweden.
Insights
Most children with vesicoureteral reflux (VUR) experience spontaneous resolution over time. This study found a high rate of VUR disappearance, especially in cases of dilated reflux, offering a favorable long-term outlook.
Area of Science:
- Pediatric Nephrology
- Urology
- Clinical Epidemiology
Background:
- Vesicoureteral reflux (VUR) is a common condition in children, increasing the risk of urinary tract infections.
- Long-term, population-based data on VUR resolution in children are limited.
- Understanding VUR natural history is crucial for guiding management strategies.
Purpose of the Study:
- To describe the long-term spontaneous disappearance of VUR in an unselected pediatric cohort.
- To identify factors influencing the rate of VUR resolution.
- To provide population-based data on VUR outcomes.
Main Methods:
- Prospective follow-up of an unselected cohort of 230 children diagnosed with VUR after their first symptomatic urinary tract infection.
- Data collected from a single children's hospital over a 15-year period.
- Kaplan-Meier survival analysis used to estimate the probability of reflux disappearance based on 164 children with multiple voiding cystourethrographies.
Main Results:
- A high probability of spontaneous VUR disappearance was observed, with 73% of children with dilated reflux (grades III-V) showing no or low-grade reflux (I) after 10 years.
- Reflux resolved faster in children with initially undilated reflux and in boys compared to girls.
- No significant association was found between age at initial investigation or bilaterality of reflux and the rate of disappearance.
Conclusions:
- This study demonstrates a favorable long-term outcome for children with VUR, characterized by a high rate of spontaneous resolution.
- The tendency for VUR disappearance, particularly in cases of dilated reflux, is more pronounced than previously reported.
- Findings support a conservative management approach for selected pediatric VUR cases given the favorable natural history.
Objective:
To describe the disappearance of reflux in children with vesicoureteral reflux, in whom there are presently no population-based long-term studies.
Design:
An unselected cohort of children with reflux detected after their first known symptomatic urinary tract infection was followed up prospectively for up to 15 years.
Setting:
A single children's hospital in a distinct geographical area at which most children with symptomatic urinary tract infection were treated.
Patients:
Two hundred thirty children--173 girls and 57 boys--with unilateral (n=130) and bilateral (n=100) reflux. Dilated reflux (grades III-V) was found in 54 patients (23.5%). The frequency of reflux was 34% in girls and 31% in boys who were examined after urinary tract infection.
Main Outcome Measure:
Disappearance of reflux.
Results:
The probability of spontaneous disappearance of reflux was estimated using Kaplan-Meier survival curves based on 164 children who underwent multiple voiding cystourethrographies. There was a marked tendency for disappearance of reflux, with 73% of children with dilated reflux having no or only grade I reflux after 10 years. Shorter persistence of reflux was found in children with undilated reflux at the initial investigation and in boys compared with girls. However, age at first investigation was not related to the rate of disappearance, and there was no difference between children with bilateral compared with unilateral reflux.
Conclusions:
This study of an unselected group of children with urinary tract infection shows a favorable long-term outcome concerning disappearance of reflux. In children with dilated reflux, this tendency was more pronounced than previously reported.