This study demonstrates that up to 27% of patients treated endoscopically may have a febrile urinary tract infection after an initial negative postoperative voiding cystourethrogram/radionuclide cystogram at 2 to 5 months and up to 92% of those will demonstrate delayed vesicoureteral reflux recurrence. Children with a history of 2 or more predictive factors, including multiple febrile urinary tract infections, dysfunctional elimination and/or renal cortical defects on dimercapto-succinic acid scan, may not be optimal candidates for Deflux. If endoscopic treatment is chosen, these patients require more vigilant followup, including late voiding cystourethrogram.
Initial nonsurgical management of high grade blunt renal trauma in children is effective and is recommended for the hemodynamically stable child. When a child has persistent symptomatic urinary extravasation delayed retroperitoneal drainage may become necessary to reduce morbidity. Minimally invasive techniques should be considered before open operative intervention. Early operative management is rarely indicated for an isolated renal injury, except in the child who is hemodynamically unstable.
Urinary tract infections can be a significant source of morbidity in the pediatric population. The mainstay of evaluating urinary tract infections in children has been physical examination, urinalysis and culture, and renal and bladder sonography and contrast cystography. However, novel clinical paradigms now consider the importance of various risk factors, such as bacterial virulence and antibiotic-resistance patterns, elimination disorders, and the role of innate immunity and inflammation in determining the likelihood of renal cortical scarring.
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