Therapeutic Management of Children with Vesicoureteral Reflux

Chirico, Valeria; Tripodi, Filippo; Lacquaniti, Antonio; Monardo, Paolo; Conti, Giovanni; Ascenti, Giorgio; Chimenz, Roberto

doi:10.3390/jcm13010244

Cited by 2 publications

(1 citation statement)

References 57 publications

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“…The optimal timing for LTAP is controversial and is individualized to each case [47]. One recent study recommended the personalized approach to LTAP recommended by some other previous studies [48]. In the cases of LTPA noncompliance, breakthrough febrile UTIs despite LTAP, or symptomatic VUR, surgical treatment could be applied.…”

Section: The Management Strategy Of Vurmentioning

confidence: 99%

The Intrarenal Reflux Diagnosed by Contrast-Enhanced Voiding Urosonography (ceVUS): A Reason for the Reclassification of Vesicoureteral Reflux and New Therapeutic Approach?

Saraga,

Saraga-Babić,

Arapović

et al. 2024

Biomedicines

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Vesicoureteral reflux (VUR) is defined as the urine backflow from the urinary bladder to the pyelo-caliceal system. In contrast, intrarenal reflux (IRR) is the backflow of urine from the renal calyces into the tubulointerstitial space. VURs, particularly those associated with IRR can result in reflux nephropathy when accompanied by urinary tract infection (UTI). The prevalence of IRR in patients with diagnosed VUR is 1–11% when using voiding cystourethrography (VCUG), while 11.9–61% when applying the contrast-enhanced voiding urosonography (ceVUS). The presence of IRR diagnosed by VCUG often correlates with parenchymal scars, when diagnosed by a 99mTc dimercaptosuccinic acid scan (DMSA scan), mostly in kidneys with high-grade VURs, and when diagnosed by ceVUS, it correlates with the wide spectrum of parenchymal changes on DMSA scan. The study performed by both ceVUS and DMSA scans showed IRRs associated with non-dilated VURs in 21% of all detected VURs. A significant difference regarding the existence of parenchymal damage was disclosed between the IRR-associated and IRR-non-associated VURs. A higher portion of parenchymal changes existed in the IRR-associated VURs, regardless of the VUR grade. That means that kidneys with IRR-associated VURs represent the high-risk group of VURs, which must be considered in the future classification of VURs. When using ceVUS, 62% of places where IRR was found were still unaffected by parenchymal changes. That was the basis for our recommendation of preventive use of long-term antibiotic prophylaxis until the IRR disappearance, regardless of the VUR grade. We propose a new classification of VURs using the ceVUS method, in which each VUR grade is subdivided based on the presence of an IRR.

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Section: The Management Strategy Of Vurmentioning

confidence: 99%

The Intrarenal Reflux Diagnosed by Contrast-Enhanced Voiding Urosonography (ceVUS): A Reason for the Reclassification of Vesicoureteral Reflux and New Therapeutic Approach?

Saraga,

Saraga-Babić,

Arapović

et al. 2024

Biomedicines

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Voiding Cystourethrography – Do We Over-do It?

Zivkovic,

Fratric,

Lukic

et al. 2024

Preprint

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Background: Voiding cystourethrography is primary used to detect vesico-ureteric reflux and is considered “gold standard” diagnostic examination for this condition. It can be ordered by pediatricians, nephrologists, emergency room pediatricians and urologists. Negative effects of Voiding cystourethrographyinclude its invasiveness, radiation exposure and risk of iatrogenic urinary tract infection. Our aim is to determine if we can reduce the number of voiding cystourethrography examinations performed at our Institute. Methods: Retrospective study was conducted with approval of the Ethical Review Board using clinical data of the patients who underwent voiding cystourethrography over the period of 12 months. Indicators (age of the patient, gender, referring specialist – urologist or nephrologists and indications for voiding cystourethrography) were analyzed using Chi-square, Fisher’s exact and Mann-Whitney test. Possible impact of the above mentioned indicators on the result of the voiding cystourethrography was analyzed using logistic regressive analysis. Results: Total of 197 voiding cystourethrographies were analyzed. Mann-Whitney U test did not show statistically significant age difference between the patients with normal (median age 3 years) and pathologic (median age 2.5 years) findings on voiding cystourethrography (Z=-0.415, p=0.678). Chi-square test showed that patients with single urinary infection and other indications have a higher chance of normal result on voiding cystourethrography (0.041 and 0.011 respectively). Logistic regressive analysis showed that patients whose referring specialist was urologist had 2.06 times higher chance for having pathologic finding on voiding cystourethrography (b=-0.810, p=0.007, odds ratio=0.445) compared to those referred by nephrologists. Conclusions: It is used as the “gold standard” radiographic test to diagnose vesicoureteral reflux. It is however associated by necessary radiation exposure. At our Institute pediatric urologists indicate voiding cystourethrography more cautiously compared to pediatric nephrologists. By avoiding voiding cystourethrography after single urinary tract infection and for other indications we could reduce the number of voiding cystourethrographies performed.

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Therapeutic Management of Children with Vesicoureteral Reflux

Cited by 2 publications

References 57 publications

The Intrarenal Reflux Diagnosed by Contrast-Enhanced Voiding Urosonography (ceVUS): A Reason for the Reclassification of Vesicoureteral Reflux and New Therapeutic Approach?

The Intrarenal Reflux Diagnosed by Contrast-Enhanced Voiding Urosonography (ceVUS): A Reason for the Reclassification of Vesicoureteral Reflux and New Therapeutic Approach?

Voiding Cystourethrography – Do We Over-do It?

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