Indications for operation and results from surgical treatment of vesicoureteral reflux

The main objective of this retrospective study was to evaluate the value of surgical approach in the treatment of children with vesicoureteral reflux (VUR). Material and method: The study was conducted in the period from January 2006 to December 2014, and included children with symptomatic VUR, who were surgically treated. A total of 72 children were treated, of whom 56 were females and 16 were males, aged between 2 and 16 years. They were treated with IV and V grade reflux ureters. Thirty-two of the unilateral refluxes were left-sided, 18 right-sided and 22 both-sided. VUR was diagnosed with Voiding cystourethrography (VCUG). Cohen technique was performed in 64 (90%) patients, Politano-Lead better technique in 4 (5%) patients and Lich-Gregoir technique in 4 (5%) patients. Results: Out of the 72 treated patients, 69 had a postoperative negative finding of VUR on the performed VCUG, indicating a high 95% success rate. In three girls, persistent postoperative reflux was found in postoperative VCUG. In the first patient persistent VUR was unilateral, of V grade. In the second patient, a third-degree VUR was found and the third patient was diagnosed with II grade VUR. Postoperatively, non-febrile UTIs (urinary tract infections) were diagnosed in 23 patients (20 female children and 3 male children) out of 72 patients in total. One female child was hospitalized with febrile UTI and 8 patients or 10% developed febrile UTI within one year of the operative treatment. Conclusion: Open surgery, despite excellent results, is used for more complicated cases, VUR grade IV – V or in previously failed cases, and it does not appear to provide definitive correction of VUR in all patients and does not prevent certain low incidence of UTI postoperatively. Non-febrile UTIs can occur several years after a surgical correction. Endoscopic treatment is an alternative treatment for VUR

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The role of voiding cystourethrography in the investigation of children with urinary tract infections

Canadian Urological Association Journal ◽

10.5489/cuaj.3610 ◽

2016 ◽

Vol 10 (5-6) ◽

pp. 210 ◽

Cited By ~ 5

Author(s):

Linda C. Lee ◽

Armando J. Lorenzo ◽

Martin A. Koyle

Keyword(s):

Urinary Tract ◽

Vesicoureteral Reflux ◽

Urinary Tract Infections ◽

Renal Scarring ◽

High Rate ◽

Voiding Cystourethrography ◽

Low Grade ◽

Endoscopic Injection ◽

Febrile Uti ◽

Tract Infections

Urinary tract infections (UTIs) represent a common bacterial cause of febrile illness in children. Of children presenting with a febrile UTI, 25‒40% are found to have vesicoureteral reflux (VUR). Historically, the concern regarding VUR was that it could lead to recurrent pyelonephritis, renal scarring, hypertension, and chronic kidney disease. As a result, many children underwent invasive surgical procedures to correct VUR. We now know that many cases of VUR are low-grade and have a high rate of spontaneous resolution. The roles of surveillance, antibiotic prophylaxis, endoscopic injection, and ureteral reimplantation surgery also continue to evolve. In turn, these factors have influenced the investigation of febrile UTIs.Voiding cystourethrography (VCUG) is the radiographic test of choice to diagnose VUR. Due to its invasive nature and questionable benefit in many cases, the American Academy of Pediatrics (AAP) no longer recommends VCUG routinely after an initial febrile UTI. Nevertheless, these guidelines pre-date the landmark Randomized Intervention of Children with Vesicoureteral Reflux (RIVUR) trial and there continues to be controversy regarding the diagnosis and management of VUR. This paper discusses the current literature regarding radiographic testing in children with febrile UTIs and presents a practical risk-based approach for deciding when to obtain a VCUG.

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Posttransplantation Vesicoureteral Reflux in Renal Grafts and Their Outcomes in Pediatric Transplantation: Should We Be Afraid ?

The Journal of Tepecik Education and Research Hospital ◽

10.5222/terh.2021.39358 ◽

2021 ◽

Author(s):

Demet Alaygut ◽

Eren Soyaltın ◽

Elif Perihan Öncel ◽

İsmail Sert ◽

Cem Tuğmen ◽

...

Keyword(s):

Urinary Tract ◽

Vesicoureteral Reflux ◽

Urinary Tract Infections ◽

Bladder Capacity ◽

Voiding Cystourethrography ◽

Post Transplantation ◽

Renal Graft ◽

Recurrent Urinary Tract Infections ◽

Tract Infections ◽

Special Assessment

Objective: Demographical, pre-transplantation and post-transplantation features and post-treatment results of four pediatric cases, who had vesicoureteral reflux (VUR) in the graft kidney, were discussed. Methods: Transplantation age, primary diagnosis, VUR to pretransplantation in native kidneys, history of bladder dysfunction, bladder capacity, results of urodynamic studies, donor and its features, induction treatments and ongoing immunosuppressive treatments, acute rejection episodes, CMV and BK infections, VUR grade in the renal graft, DMSA results, treatment type and its outcomes, and the renal graft functions of four patients who underwent kidney transplantation at Tepecik Training and Research Hospital between 2008 and 2016 and for whom VUR was determined via voiding cystourethrography (VCUG) due to recurrent urinary tract infections, were evaluated. Results: All of four cases were female. Their mean transplantation age was 8.7 years (5-16). High grade (Grade 4) VUR was determined in the graft kidney in all but one. DMSA included multiple scar foci apart from one case having low grade VUR. Cases were primarily treated endoscopically and then by open surgery. Spontaneous recovery occurred in one case. Graft dysfunction was not observed in any of the cases. Conclusion: VUR is an important risk factor in recurrent urinary tract infections after post-transplantation. A special assessment should be done for the patient in the presence of VUR and conservative and surgical treatments should be executed together. It should be remembered that VUR can be spontaneously regressed by the bladder capacity increasing treatments and prophylaxis.

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The Role of Radiographic Imaging in Diagnosis and Follow-up of Vesicoureteral Reflux: Review Article

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i39a32165 ◽

2021 ◽

pp. 231-239

Author(s):

Mahmoud Elsayed Mahmoud Fadl ◽

Anwar Suwailem Almutairi ◽

Amal Muteb S. Alshalan

Keyword(s):

Vesicoureteral Reflux ◽

Voiding Cystourethrography ◽

Radiographic Imaging ◽

Colour Doppler ◽

Group Members ◽

Tract Infections ◽

Ionizing Radiations ◽

Primary Vesicoureteral Reflux

Background: Primary vesicoureteral reflux is a basic influencing for urinary tract infections in children. The basic technique for the diagnosis of vesicoureteral reflux is voiding cystourethrography, accompanied with cystoscintigraphy. Voiding cystourethrography has the benefit of only minor irradiation. However it does no longer permit the morphological assessment of bladder and vesicoureteral reflux grading. Colored-Doppler cystosonography with echocontrast is a currently delivered technique for imaging vesicoureteral reflux. The purpose of our study is to explore the role of Radiographic Imaging in diagnosis and follow‐up of vesicoureteral reflux. Method: A systematic review was carried out, (including PubMed, Google Scholar, and EBSCO) of imaging modalities used to detect or evaluate vesicoureteral reflux disease. The found articles were screened by titles, and abstracts. No software will be utilized to analyze the data. The review was performed by the group members and each verified by at least two, to ensure the validity and minimize the mistakes. Results and Conclusion: Colour-Doppler cystosonography, due to the nonexistence of ionizing radiations, has great benefits, mainly in cases requiring continued or prolonged monitoring. In spite of practices stated in the literature, this procedure has a role in the diagnosis of vesicoureteral reflux. Our group chooses colour-Doppler cystosonography for the follow-up of medium-severe grade vesicoureteral reflux previously diagnosed by radiology and/or scintigraphy. Cystoscintigraphy is used only to confirm cases resulting negative at ultrasonography.

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Voiding Cystourethrography

10.2310/uro.11040 ◽

2017 ◽

Author(s):

Lane S Palmer ◽

Adam S Howe

Keyword(s):

Vesicoureteral Reflux ◽

Bladder Capacity ◽

Posterior Urethral Valves ◽

Voiding Cystourethrography ◽

Voiding Cystourethrogram ◽

Reduce Radiation Exposure ◽

Patient Preparation ◽

Febrile Urinary Tract Infections ◽

Tract Infections ◽

And Function

The voiding cystourethrogram (VCUG) is a fluoroscopic examination commonly used in pediatrics to assess the presence of vesicoureteral reflux (VUR) disease and the structure and function of the bladder and urethra. Along with hydronephrosis and febrile urinary tract infections, the indications for VCUG are vast. Protocols set in place and modern techniques have helped reduce radiation exposure during VCUG to 1.7 to 5.2 mrad. Proper patient preparation and sterile technique during catheter placement are of the upmost importance. The bladder is filled with contrast to the patient’s capacity, followed by the patient voiding. A scout film (anteroposterior [AP]) along with views of early filling (AP), bladder capacity (AP and oblique), voiding (AP and oblique), and postvoid (AP) are obtained. VUR is diagnosed, and its grading system is determined by the VCUG study. Cyclic VCUG, PIC cystography, and radionucleotide VCUG are alternative techniques in diagnosing VUR. Neurogenic bladder, along with its associated pathologies, can be easily characterized by the VCUG examination, as can cloacal and urogenital sinuses via the contrasted study. Bladder ruptures, bladder masses, urachal anomalies, functional disorders of the bladder neck, and a host of urethral pathologies (most notably posterior urethral valves) can be diagnosed by VCUG. This review contains 62 highly rendered figures, 6 tables, and 9 references Key words: voiding cystourethrography, fluoroscopy, radiology, imaging, pediatric, urology, vesicoureteral reflux

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The Diagnosis and Treatment of Vesicoureteral Reflux: An Update

The Open Urology & Nephrology Journal ◽

10.2174/1874303x01508010096 ◽

2015 ◽

Vol 8 (1) ◽

pp. 96-103 ◽

Cited By ~ 1

Author(s):

Adam Rensing ◽

Paul Austin

Keyword(s):

Urinary Tract ◽

Vesicoureteral Reflux ◽

Renal Scarring ◽

Reflux Nephropathy ◽

Bowel Dysfunction ◽

Alternative Approach ◽

Febrile Uti ◽

Febrile Urinary Tract Infections ◽

Tract Infections ◽

Pediatric Providers

Vesicoureteral reflux [VUR] remains a common problem seen by pediatric providers. Despite a great deal of research, the debate regarding how to screen and treat patients reremains tense and controversial. This review seeks to summarize the management of VUR with emphasis on recent published findings in the literature and how they contribute to this debate. The goals of managing VUR include preventing future febrile urinary tract infections [FUTI], renal scarring, reflux nephropathy and hypertension. The topdown approach with upper tract imaging and selective vesicocystourethrogram [VCUG] is an emerging alternative approach in the evaluation of children after their first FUTI. The elimination of bladder and bowel dysfunction [BBD] is an important management strategy to prevent further FUTIs, regardless of treatment choice. Antibiotic prophylaxis is a safe and effective modality to sterilize the urinary tract. Endoscopic treatment of VUR is an attractive modality in select patients, although some concerns remain regarding its effectiveness and durability as compared to to the gold standard of open or laparoscopic ureteroneocystostomy. Lastly, further research is required to determine the most effective algorithm to evaluate the pediatric patient after the first febrile UTI.

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Allograft Vesicoureteral Reflux after Kidney Transplantation

Medicina ◽

10.3390/medicina58010081 ◽

2022 ◽

Vol 58 (1) ◽

pp. 81

Author(s):

Alessandra Brescacin ◽

Samuele Iesari ◽

Sonia Guzzo ◽

Carlo Maria Alfieri ◽

Ruggero Darisi ◽

...

Keyword(s):

Renal Function ◽

Kidney Transplantation ◽

Vesicoureteral Reflux ◽

Clinical Manifestations ◽

Current Evidence ◽

Voiding Cystourethrography ◽

Implantation Technique ◽

Creatinine Concentration ◽

Dialysis Vintage ◽

Tract Infections

Allograft vesicoureteral reflux (VUR) is a leading urological complication of kidney transplantation. Despite the relatively high incidence, there is a lack of consensus regarding VUR risk factors, impact on renal function, and management. Dialysis vintage and atrophic bladder have been recognized as the most relevant recipient-related determinants of post-transplant VUR, whilst possible relationships with sex, age, and ureteral implantation technique remain debated. Clinical manifestations vary from an asymptomatic condition to persistent or recurrent urinary tract infections (UTIs). Voiding cystourethrography is widely accepted as the gold standard diagnostic modality, and the reflux is generally graded following the International Reflux Study Committee Scale. Long-term transplant outcomes of recipients with asymptomatic grade I-III VUR are yet to be clarified. On the contrary, available data suggest that symptomatic grade IV-V VUR may lead to progressive allograft dysfunction and premature transplant loss. Therapeutic options include watchful waiting, prolonged antibiotic suppression, sub-mucosal endoscopic injection of dextranomer/hyaluronic acid copolymer at the site of the ureteral anastomosis, and surgery. Indication for specific treatments depends on recipient’s characteristics (age, frailty, compliance with antibiotics), renal function (serum creatinine concentration < 2.5 vs. ≥ 2.5 mg/dL), severity of UTIs, and VUR grading (grade I-III vs. IV-V). Current evidence supporting surgical referral over more conservative strategies is weak. Therefore, a tailored approach should be preferred. Properly designed studies, with adequate sample size and follow-up, are warranted to clarify those unresolved issues.

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The additive impact of the distal ureteral diameter ratio in predicting early breakthrough urinary tract infections in children with vesicoureteral reflux

Journal of Pediatric Urology ◽

10.1016/j.jpurol.2021.01.003 ◽

2021 ◽

Author(s):

Victoria L. Troesch ◽

Moshe Wald ◽

Megan A. Bonnett ◽

Douglas W. Storm ◽

Gina M. Lockwood ◽

...

Keyword(s):

Urinary Tract ◽

Vesicoureteral Reflux ◽

Urinary Tract Infections ◽

Diameter Ratio ◽

Tract Infections

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Adherence to guideline recommendations for urinary tract infections in adult women: a cross-sectional study

Primary Health Care Research & Development ◽

10.1017/s1463423621000116 ◽

2021 ◽

Vol 22 ◽

Author(s):

Rian Lelie- van der Zande ◽

Marcel Bouvy ◽

Martina Teichert

Keyword(s):

Urinary Tract ◽

Clavulanic Acid ◽

Cross Sectional Study ◽

Adult Women ◽

Sectional Study ◽

Cross Sectional ◽

First Choice ◽

Febrile Uti ◽

Amoxicillin Clavulanic Acid ◽

Tract Infections

Abstract Aim: To study whether changes in drug preferences in the Dutch guideline for the treatment of Urinary Tract Infection (UTI) for General Practitioners (GPs) in 2013, resulted in corresponding changes in antibiotic dispensing. Background: For the treatment of uncomplicated UTI, nitrofurantoin remained the first choice, while fosfomycin became the second choice and changed ranks with trimethoprim. For a subsequent febrile UTI, ciprofloxacin became the first choice and changed ranks with amoxicillin/clavulanic acid, co-trimoxazole remained the third choice. Methods: In this observational cross-sectional study, routinely collected dispensing data from the Dutch Foundation of Pharmaceutical Statistics from 2012 to 2017 were used. The number of women 18 years and older, treated with one of the guideline antibiotics for uncomplicated UTI and subsequent febrile UTI were analysed annually. Proportions were calculated. Data were stratified for age categories. Failure of uncomplicated UTI treatment was defined as the dispensing of an antibiotic for febrile UTI within 14 days after the dispensing of an antibiotic for uncomplicated UTI. Findings: Data were available from 81% of all pharmacies in 2012 to 89% in 2017. Percentages of women dispensed nitrofurantoin were relatively stable with 87.4% in 2012 and 84.4% in 2017. Percentages of women dispensed fosfomycin increased from 5.4% in 2012 to 21.8% in 2017, whereas percentages of women dispensed trimethoprim decreased from 17.8% to 8.0%. Within age categories, the percentage of women dispensed fosfomycin increased from 12.4% in women 18–30 years old to 36.7% in women above 80 years old. Percentages of women dispensed antibiotics for febrile UTI remained stable at 5% annually. Percentages of women receiving ciprofloxacin increased from 1.9% in 2012 to 3.3% in 2017, while those receiving amoxicillin/clavulanic acid decreased from 2.9% to 1.8%. New guideline recommendations resulted in corresponding changes in dispensed antibiotics for uncomplicated UTI and subsequent febrile UTI. Drug choices differed for age categories.

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