Materiały źródłowe

• #1 Vesicoureteral Reflux – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563262/

  Vesicoureteral reflux (VUR) is the most prevalent urological abnormality in neonates, occurring in approximately 1% of all newborns. […] However, this percentage rises significantly, up to 15%, in those diagnosed with prenatal hydronephrosis. […] VUR is 3 times more prevalent in White than Black patients and twice as likely in women than men, except for cases identified with prenatal hydronephrosis, where VUR is more commonly found in boys. […] A systematic review of 34 studies indicated that approximately 16% of neonates with ultrasound evidence of hydronephrosis eventually have VUR. […] When tested, about 30% to 40% of children with a febrile UTI exhibit some degree of VUR, compared to 17% of patients without UTI evidence. […] A genetic predisposition for the disorder exists, as up to two-thirds of children born to women with primary VUR will also exhibit the condition.

• #2 Vesicoureteral Reflux: Practice Essentials, Background, Relevant Anatomy

  https://emedicine.medscape.com/article/439403-overview

  VUR affects 1% to 2% of all children, and up to one-third of children with VUR will experience urinary tract infection (UTI). The incidence of VUR in children with febrile UTIs is estimated to be 30-40%. […] VUR is 10 times as common in white children as in black children, and children with red hair are recognizably at an increased risk. VUR is more prevalent in male newborns, but VUR seems to be 5-6 times more common in females older than one year than in males. The incidence decreases as patient age increases. […] At present, the incidence of prenatally diagnosed hydronephrosis caused by VUR ranges from 17-37% in the pediatric population, and approximately 20-30% of children with VUR present with renal lesions. The incidence of VUR in children and young adults with end-stage renal failure (chronic renal insufficiency [CRI]) that necessitates therapy (dialysis or transplantation) is about 6%. VUR is the fifth-most-common cause of CRI in children.

• #3 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Vesicoureteral-Reflux-Epidemiology.aspx

  Affecting up to 2% of the pediatric population, VUR is the most common urinary tract pathology in children. […] Furthermore, it is present in up to 4 out of every 10 pediatric UTI cases. […] The prevalence of VUR is higher among younger infants and this prevalence progressively decreases in older age groups. […] In one study, it was shown that approximately 70% of infants under the age of 12 months who presented with UTI had VUR. […] By the age of 4 years, 12 years, and post adolescence, the percentage of patients presenting with a UTI who also had VUR dropped to 25%, 15% and 5.2%, respectively. […] The global incidence of VUR per region is not thoroughly described in contemporary literature. […] However, it is believed to be fairly similar between North America and Europe. […] With regards to racial differences, VUR is more prevalent in the Caucasian pediatric population when compared to others.

• #4 Vesicoureteral reflux – Wikipedia

  https://en.wikipedia.org/wiki/Vesicoureteral_reflux

  The American Urological Association recommends ongoing monitoring of children with VUR until the abnormality resolves or is no longer clinically significant. The recommendations are for annual evaluation of blood pressure, height, weight, analysis of the urine, and kidney ultrasound. […] The prevalence of VUR is difficult to ascertain at any one time, it differs depending on the population looked at. The prevalence of VUR in healthy children has been estimated 0.4-1.8% However in children with UTI the prevalence is up to 30%. Probably the prevalence in healthy population is significantly higher than the traditional estimates, up to 10% of the population. […] Four times as many girls as boys are diagnosed with VUR during childhood. Boys most commonly present during their first year, and girls present more cumulatively throughout childhood.

• #5 Pediatric Vesicoureteral Reflux: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1016439-overview

  The overall prevalence of VUR has not been defined, because many children are asymptomatic and the invasive testing required for diagnosis is performed only when clinically indicated. Several older reports of imaging studies performed on healthy children prior to oversight by institutional review boards demonstrated rates of 1-2%, but most of these studies were small and did not clearly characterize their subject populations. The evidence is clear that the prevalence of VUR is higher among children with UTIs (15-70%, depending on age). Among infants antenatally identified with hydronephrosis on US, approximately one third were postnatally found to have VUR. […] The incidence of reflux clearly is influenced by genetic factors, though specific modes of inheritance have yet to be identified. Siblings of children with VUR have a 25-33% risk of also having VUR, whereas offspring of parents with reflux have a 66% incidence (higher in female offspring than male offspring). Even when asymptomatic, these siblings and offspring can have high-grade reflux and often have renal scarring at evaluation.

• #6 What is the normal prevalence of vesicoureteral reflux? – PubMed

  https://pubmed.ncbi.nlm.nih.gov/11009294/

  The prevalence of vesicoureteral reflux in normal children has been estimated to be 0.4% to 1.8%. […] Based on epidemiological data, it can be estimated that 2.2% of girls and 0.6% of boys may be found to have reflux as a result of the investigation of urinary tract infection. […] The prevalence of vesicoureteral reflux in children with urinary tract infection was 31.1% (95% CI: 29.9-32.8). […] The prevalence in normal kidneys was 17.2% (95% CI: 14.4-20.1). […] Vesicoureteral reflux is common in nearly all patient groups examined. […] The prevalence of vesicoureteral reflux in normal children is probably significantly higher than the traditional estimates.

• #7 Vesicoureteral Reflux (VUR) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/vesicoureteral-reflux-vur

  VUR is a condition that affects about 1 to 3 percent of all children. However, there are certain groups of children in whom VUR is much more common, including: […] Children who have hydronephrosis, or excessive fluid in the kidneys. Among this group, VUR is seen in about 15 percent of these children when testing is done after the baby is born. […] Children who have a urinary tract infection, particularly if the infection was associated with a fever. Among this group, VUR is found in 50 to 70 percent of these children. […] We usually see patients with VUR every six to 12 months. Infants may be seen more often. For children with persistent VUR, we recommend VUR testing every year to two years, depending on the child’s age. […] Your doctor often will use ultrasound to follow your child’s kidney growth and health. We perform special tests to check for VUR every one to two years. In some cases, VUR can result in scarring in the kidney, which can lead to high blood pressure. Children with scars in their kidneys should have their blood pressure and urine checked every six months, even if their VUR has gone away.

• #8 Vesicoureteral Reflux Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/vesicoureteral-reflux-guideline

  Vesicoureteral reflux (VUR) and urinary tract infections (UTI) may detrimentally affect the overall health and renal function in affected children. This clinical guideline covers assessment, initial management, surgical treatment, and follow-up management of pediatric patients with such disorders. […] In 1997, the American Urological Association (AUA) published the Guideline on the Management of Primary Vesicoureteral Reflux in Children. Since that time there has been an expanding body of literature involving not only the evaluation and the management of vesicoureteral reflux (VUR) but also the role of screening in its management. […] The prevalence of VUR is approximately 27% in siblings of children with VUR. The screening methods to detect VUR include voiding cystourethrogram (VCUG) or radionuclide cystography. Some practitioners use renal ultrasonography to screen for renal abnormalities as a selection criterion for voiding cystography. The goal of screening for VUR in siblings or neonates with prenatally detected hydronephrosis is to identify clinically unapparent VUR in order to initiate preventative therapy, usually CAP. However, the value of CAP in preventing febrile UTI and renal damage in VUR is unproven. Therefore, recommendations for screening are limited by the uncertainty of any potential benefit gained by identifying VUR. Identification of VUR may be of some benefit by increasing the awareness of parents and health providers to the potentially increased risk of pyelonephritis and renal scarring. […] In siblings of children with VUR, a voiding cystourethrogram or radionuclide cystogram is recommended if there is evidence of renal cortical abnormalities or renal size asymmetry on ultrasound or if there is a history of urinary tract infection in the sibling who has not been tested.

• #9 Prevalence of VUR in children – Deflux

  https://deflux.com/hcp/vesicoureteral-reflux/pediatric-vur/

  Vesicoureteral reflux (VUR), commonly referred to as urinary reflux, is the most common congenital urinary anomaly to occur during childhood. It is defined as the abnormal retrograde flow of urine from the bladder into the upper urinary tract through an incompetent ureterovesical junction. The prevalence of reflux varies with several demographic factors of the patient population. Reflux may occur as an isolated entity or with other associated anomalies of the genitourinary tract. Urinary reflux usually presents during the first few years of life. Up to 1.8% of all children are affected by VUR. […] Siblings of individuals diagnosed with VUR have about a 35% probability of developing VUR. The children of individuals diagnosed with VUR have up to a 50% chance of developing VUR. […] The prototypical patient with VUR is a Caucasian girl younger than 4 years of age with a history of UTIs. Average VUR diagnosis occurs between 2-3 years old. 80% of children evaluated for a UTI and diagnosed with VUR are girls. Light skinned children are at greater risk for VUR, compared with black children and children of Mediterranean origin.

• #10 Pediatric Vesicoureteral Reflux: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1016439-overview

  Screening of asymptomatic siblings and offspring continues to be an area of controversy. Advocates have pointed out that early identification of children with reflux may prevent episodes of UTI and renal scarring, but other authorities have argued that screening asymptomatic individuals is likely to result in significant overtreatment of clinically insignificant VUR, with associated morbidity. As a middle ground, some pediatric urologists screen newborn siblings of children with VUR but do not screen their older, asymptomatic siblings. […] VUR is more common among infants and progressively resolves in a substantial proportion of children; thus, prevalence decreases as children age. One study of patients who presented with UTI reported prevalence figures of 70% in patients younger than 1 year, 25% in patients aged 4 years, 15% in those aged 12 years, and 5.2% in adult patients.

• #11 Pediatric Vesicoureteral Reflux: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1016439-overview

  UTIs are more common in females, as one might expect from the anatomic differences. This leads to greater screening and, therefore, diagnosis of VUR in females. However, among all children with UTI, boys are more likely to have VUR than girls are (29% vs 14%). Boys also tend to have higher grades of VUR diagnosed at younger ages, but their reflux is more likely to resolve. […] Reflux has been reported to be more common in White children than in those of other races. This disparity extends to children with antenatal hydronephrosis. The editor of this article reviewed his antenatal registry of 1019 patients with antenatal hydronephrosis and found a 15% incidence of VUR in African American patients enrolled in the registry, which is comparable to the overall prevalence of VUR among patients with antenatal hydronephrosis.

• #12 Pediatric Vesicoureteral Reflux: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1016439-overview

  The strength of the evidence supporting the view that VUR is less common in Black children has been questioned, and the very premise of race-based medicine and race-based decision-making is now recognized to have no biologic basis. Therefore, children with UTI, antenatal hydronephrosis, and VUR itself should be managed similarly, irrespective of race.

• #13 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Can-Vesicoureteral-Reflux-be-Inherited.aspx

  The most common form of urinary tract pathology in the pediatric population is vesicoureteral reflux (VUR). […] Diagnosis is based upon suitable tests, including urinalysis, together with imaging and urodynamic studies. […] In mild cases, surveillance alone may be opted for, since VUR tends to resolve spontaneously as the child grows. […] A genetic component to VUR is strongly suggested by studies that highlight the well-recognized recurrence of the condition in certain families. […] Studies show that up to half of all children affected with VUR are from a family with a positive history for VUR. […] The mode of inheritance of VUR has varying patterns as shown in different studies. […] More research is therefore essential for the elucidation of VUR and its genetic basis.

• #14 Vesicoureteral Reflux – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563262/

  The incidence of primary VUR is very high in twins. […] Among siblings, the incidence of VUR is about 30%, although routine screening of asymptomatic siblings with normal renal ultrasound examinations is presently not recommended. […] VUR may also be associated with other congenital conditions such as posterior urethral valves, neurogenic bladder, spina bifida, urinary outlet obstruction, bladder overactivity, imperforate anus, ureterocele, and bladder exstrophy. […] The initial evaluation starts with a urinalysis (dipstick and microscopic), including an evaluation for proteinuria and bacteriuria and a urine culture and sensitivity, if indicated. […] In addition, obtaining a baseline creatinine level is advisable to establish baseline renal function, particularly in severe cases. […] Renal ultrasonography is recommended for both initial and follow-up examinations to evaluate renal anatomy, cortical thickness, the presence of hydronephrosis, and any structural abnormalities.

• #15 Vesicoureteric reflux | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/vesicoureteric-reflux?lang=us

  The incidence of urinary tract infection is 8% in females and 2% in males. Among children with urinary tract infections, the incidence of vesicoureteric reflux rises to ~ 25-40%. […] Significant vesicoureteral reflux, if untreated, may lead to recurrent urinary tract infections, renal scarring, and eventually renal failure (reflux nephropathy). […] Voiding cystourethrogram (also known as micturating cystourethrogram) should be performed after the first well-documented urinary tract infection up to the age of 6 years. […] Routine ultrasound is usually also performed (in addition to voiding cystourethrogram) to assess the renal parenchyma for evidence of scarring or anatomic anomalies. […] Reflux can also be graded, although less precisely, with nuclear cystography. There is no universally accepted grading system for nuclear cystography, with most radiologists simply using the terms mild, moderate, and severe.

• #16 Predictors of High-grade Vesicoureteral Reflux in Children with Febrile Urinary Tract Infections

  http://chikd.org/journal/view.php?id=10.3339/jkspn.2017.21.2.136

  This study aimed to investigate clinical and radiological factors that may predict high-grade vesicoureteral reflux (VUR) in patients with febrile urinary tract infection (UTI). […] UTI is often associated with primary vesicoureteral reflux (VUR), and primary VUR is diagnosed in about 25-50% of children with UTIs undergoing voiding cystourethrography (VCUG). […] Therefore, confirming high-grade VURs may help to improve prognoses for pediatric patients with VURs. […] The results of the present study also showed a higher frequency of recurrent UTI in high-grade VUR patients, suggesting that VCUG should be considered in recurrent UTI patients. […] In conclusion, patients with high-grade VUR had a higher incidence of non-E. coli UTI and higher rate of recurrent UTI, and they showed severe abnormal findings on RBUS and DMSA renal scans compared to patients with low-grade VUR or those without VUR. It is desirable to perform VCUG selectively when there are hydronephrosis, ureter dilatation findings in RBUS, multiple cortical defect or difference of uptake difference of both kidneys in DMSA renal scan.

• #17 Outcomes in children with vesicoureteral reflux receiving antibiotic prophylaxis | Antimicrobial Stewardship & Healthcare Epidemiology | Cambridge Core

  https://www.cambridge.org/core/journals/antimicrobial-stewardship-and-healthcare-epidemiology/article/outcomes-in-children-with-vesicoureteral-reflux-receiving-antibiotic-prophylaxis/EDFE9BE3FB8DE492D4CAEC2E731740A2

  Antibiotic prophylaxis in children with vesicoureteral reflux (VUR) remains controversial. […] Recurrent UTIs in patients with and without urologic anomalies occurred in 57% and 33%, respectively. […] Vesicoureteral reflux (VUR) is prevalent among children diagnosed with febrile urinary tract infections (UTIs), occurring in up to 35% of children with a first UTI, with underlying urologic anomalies being a common risk factor. […] Daily antibiotic prophylaxis has been utilized in children with VUR, in an effort to reduce UTI recurrence, but remains variable by institution and among providers. […] Our study aimed to provide additional data for this practice by determining incidence of UTI recurrence in children receiving antibiotic prophylaxis for VUR, including those with urologic anomalies.

• #18 Outcomes in children with vesicoureteral reflux receiving antibiotic prophylaxis | Antimicrobial Stewardship & Healthcare Epidemiology | Cambridge Core

  https://www.cambridge.org/core/journals/antimicrobial-stewardship-and-healthcare-epidemiology/article/outcomes-in-children-with-vesicoureteral-reflux-receiving-antibiotic-prophylaxis/EDFE9BE3FB8DE492D4CAEC2E731740A2

  The primary outcome was the incidence of a recurrent UTI within 24 months after initiation of antibiotic prophylaxis. […] Patients with urologic anomalies had the highest rate of recurrence with 8 of 14 patients (57%). […] The major findings of this study are that 33% of patients without urologic anomalies receiving antibiotic prophylaxis had recurrence of UTIs and 33% of organisms cultured at the time of first recurrence were resistant to the initial prophylactic antibiotic. […] Patients with urologic anomalies had the highest rate of recurrence at 57% within 24 months. […] Given the conflicting evidence available, some investigators have attempted to identify risk factors for UTI recurrence, in which benefits may outweigh the risks of antibiotic prophylaxis. […] Our description of a subset of patients with urologic anomalies receiving antibiotic prophylaxis also showed a high rate of UTI recurrence, highlighting the risk of antibiotic prophylaxis in a group of patients who may benefit from a procedural intervention for secondary VUR.

• #19 Society for Pediatric Urology – Discontinuation of antibiotic prophylaxis in patients with persistent primary vesicoureteral reflux initially detected during infantile period -outcome analysis and risk factors for febrile urinary tract infection

  https://fallcongress.spuonline.org/abstracts/2013/10.cgi

  According to the AUA guideline on management of primary vesicoureteral reflux (VUR) in children, conservative management with continuous antibiotic prophylaxis (CAP) is indicated as an initial management for children with primary VUR detected at less than 1 year of age. […] In this study, we retrospectively reviewed our experience of active surveillance in patients with persistent primary VUR initially detected during infantile period and assessed risk factors for febrile urinary tract infection (fUTI). […] Outcome of active surveillance without CAP and risk factors for fUTI were analyzed. […] Febrile UTI free rate was 70.6% and 51.2% at 5 years and 10 years after discontinuation of CAP. […] This study revealed that more than half of the patients with persistent VUR were free from fUTI during 10 years active surveillance after discontinuation of CAP and that new scar formation was observed in only the limited number of patients with fUTI. Accordingly, active surveillance seems to be safe option. Those with dilated VUR on follow-up VCUG were significantly at higher risk for febrile UTI under active surveillance for persistent VUR.

• #20 What is the best treatment for children with vesicoureteral reflux? | ScienceDaily

  https://www.sciencedaily.com/releases/2010/05/100520102915.htm

  Children with vesicoureteral reflux (VUR), in which urine flows backwards into the kidneys from the bladder, have been treated in the past with surgery or antibiotic therapy. […] Although this condition can lead to renal damage, there have been few controlled studies to help determine the most effective treatment of young children. […] „Controlled studies are needed to provide an evidence base for treatment in children with VUR,” according to lead investigator Sverker Hansson, MD. […] The Swedish Reflux Trial was set up as a RCT to compare long-term antibiotic prophylaxis, endoscopic correction and surveillance as the control group in children with dilating VUR in regard to the febrile UTI rate, and kidney and VUR status at 2 years. […] The febrile UTI rate differed significantly between treatment groups in girls, including a recurrence rate of 57% in the surveillance, 23% in the endoscopic and 19% in the prophylactic groups. […] An interesting finding was that new damage as well as the progression of previously observed renal uptake defects was only seen in kidneys drained by ureters with dilating VUR with 1 exception.

• #21 Therapeutic Management of Children with Vesicoureteral Reflux

  https://www.mdpi.com/2077-0383/13/1/244

  According to the Italian Society of Pediatric Nephrology (SiNePe), VUR represents a risk factor for UTI development, distinguishing two different entities related to it, “reflux disease” and “reflux symptom”; the first involves predominantly males, with a rare incidence, prenatally or under two years of age, with severe VUR (stage IV–V), abnormal renal parenchyma and urinary tract, and spontaneous resolution in 50% of cases. […] The second and more common form of VUR is usually assessed in females, with low-grade I–III VUR, associated with normal kidneys and urinary tract, with a high rate of resolution (80–90%). […] A voiding cystourethrogram (VCUG) is the “gold standard” for VUR detection, allowing grading of the severity from a wisp of contrast just beyond the bladder with no dilatation of the ureter or collecting system (grade I) up to dilatation and tortuosity of the ureters with calyceal clubbing (grade V).

• #22 Periureteral Bulking Agents for the Treatment of Vesicoureteral Reflux (VUR)

  https://www.southcarolinablues.com/web/public/brands/medicalpolicy/external-policies/periureteral-bulking-agents-for-the-treatment-of-vesicoureteral-reflux-vur/

  Most commonly seen in children, vesicoureteral reflux (VUR) is the retrograde flow of urine from the bladder upward toward the kidney. […] Approximately one third of children with UTIs are found to have VUR. […] The average age for UTI onset is 2 to 3 years, corresponding to the age when toilet training occurs. […] The criterion standard for diagnosis is voiding cystourography, a procedure that involves catheterization of the bladder. […] Treatment strategies for VUR include bladder training, antibiotic prophylaxis, and surgical modification of the ureter to correct the underlying reflux. […] VUR is likely to resolve spontaneously over 1 to 5 years; lower grades of reflux (i.e., grades I and II) are associated with a higher probability of spontaneous resolution. […] The decision to administer prophylactic antibiotic treatment includes consideration of potential adverse events of long-term antibiotic treatment, which can include allergic reactions and development of treatment-resistant bacteria resulting in breakthrough UTIs.

• #23 Therapeutic Management of Children with Vesicoureteral Reflux

  https://www.mdpi.com/2077-0383/13/1/244

  Other tests have been proposed to detect reflux, such as contrast-enhanced voiding urosonography (ceVUS), an ionizing radiation-free technique using ultrasound with a contrast agent instilled into the bladder to image the urinary tract. […] However, prospective and larger studies are needed to confirm the role of these or other biomarkers as alternative, non-invasive tools to VCUG and ceVUS. […] The choices of the patients and the radiological test to perform are not unique challenges, considering that the therapeutic approach of VUR is a matter of debate. […] Spontaneous resolution of VUR can be observed in about more than 80% of grades I and II, around 45% of grade III, and less than 10% of grades IV and V. […] According to the main international guidelines, VUR therapy is based on three strategies, depending on the severity of VUR and physicians’ preferences.

• #24 Vesicoureteral Reflux – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563262/

  The initial imaging method for a child experiencing their first febrile UTI typically involves renal ultrasound, with VCUG being recommended if sonography reveals abnormalities, a second UTI occurs, or if the patient presents with other high-risk factors such as bowel or bladder dysfunction. […] Continuous antibiotic prophylaxis is typically administered to prevent UTIs. […] The latest guidelines from the American Urological Association (AUA) Pediatric Vesicoureteral Reflux Guidelines Panel recommend continuous antibiotic prophylaxis for children aged 1 or younger with VUR who have a history of febrile UTI, high-grade reflux (grades III-V), or concurrent bladder or bowel dysfunction. […] Continuous prophylaxis was once the standard treatment for VUR but is now considered optional for non-high-risk patients over the age of 1.

• #25 Vesicoureteral Reflux – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563262/

  The management of VUR has evolved and depends on the presence and frequency or absence of febrile UTIs, the age and phenotypic sex of the patient, the presence of bladder or bowel dysfunction, and the VUR grade. […] Spontaneous resolution of VUR frequently occurs before age 5, especially in younger patients, males, and those with lower VUR grades (I-III), making surgical intervention unnecessary in uncomplicated cases. […] Surgical intervention should be considered for patients experiencing recurrent UTIs, progressive renal damage, additional scarring, or inadequate kidney growth despite continued prophylaxis.

• #26 Vesicoureteral Reflux: Classification, Diagnosis, and Treatment

  https://www.urology-textbook.com/vesicoureteral-reflux.html

  Conservative arm of the international reflux study, randomized, n=149, follow-up 10 years of long-term antimicrobial prophylaxis in VUR IIIV: 52% no longer have reflux, 25% VUR without dilatation, 23% have VUR with dilatation. Spontaneous healing of reflux is likely for VUR grade IV, unilateral reflux, and children 5 years (Smellie et al., 2001a). […] Conservative arm of the Swedish reflux study, randomized, n=203 children between 12 years old with dilating reflux grade IIIV, follow-up 2 years: 39-47% spontaneous improvement in VUR. Boys showed a good prognosis even without antibiotic prophylaxis. Girls often had recurrent UTIs, which could be avoided by antibiotic prophylaxis (Brandström et al., 2010).

• #27 Management of vesicoureteral reflux – UpToDate

  https://www.uptodate.com/contents/management-of-vesicoureteral-reflux

  Vesicoureteral reflux (VUR) is the retrograde passage of urine from the bladder into the upper urinary tract. The clinical significance of VUR has been based on the premise that it predisposes patients to acute pyelonephritis by transporting bacteria from the bladder to the kidney, which may lead to kidney scarring, hypertension, and end-stage kidney disease. Some aspects of this long-held belief have been increasingly questioned. As a result, there is controversy regarding the optimal management of patients with VUR. A study based on United States Renal Data System reported a steady decrease in new-onset end-stage kidney disease secondary to reflux nephropathy in the United States. Though attributed to the possibility of improvements in medical management and diagnostic practices, the possibility of inclusion of cases with congenital reflux nephropathy in earlier studies cannot be ruled out. […] The management of VUR diagnosed after a urinary tract infection (UTI) will be reviewed here. […] The goals of VUR management include: Prevention of recurrent urinary tract infections (UTIs) […] Prevention of worsening kidney damage (eg, kidney scarring).

• #28

  https://journals.lww.com/ursc/fulltext/2021/32020/conservative_management_of_vesicoureteral_reflux_.3.aspx

  Vesicoureteral reflux (VUR) is defined as the retrograde flow of urine from the bladder to the upper urinary tract (the ureters and kidneys), caused by ureterovesical junction dysfunction. […] Currently, comprehensive data on the epidemiology of VUR is unavailable. Several studies provide limited data on the VUR prevalence in pediatric populations, i.e., approximately 1%. […] VUR is more commonly diagnosed in girls, with a ratio of approximately 3:1. […] Due to its often asymptomatic nature, VUR is commonly diagnosed as an incidental finding to evaluate other urinary tract conditions. […] For example, in children with urinary tract infection (UTI), the VUR prevalence is approximately 40% and 16% in fetuses diagnosed with hydronephrosis prenatally. […] VUR is also a common finding in patients with congenital urinary tract abnormalities, such as posterior urethral valves, cloacal deformities, and duplex kidneys.

• #29 Managing vesicoureteral reflux in children:… | F1000Research

  https://f1000research.com/articles/8-29

  Current management of vesicoureteral reflux (VUR) in children is the result of a steady albeit controversial evolution of data and thinking related to the clinical impact of VUR and urinary tract infection (UTI) in children, the value of clinical screening, and the relative impact of testing and interventions for VUR. […] The true incidence and clinical significance of VUR in the general population are unknown, but the current reported values are impacted by sampling error and selection bias due to the fact that the majority of screenings and diagnoses of VUR are related to a patients history of urinary tract infections (UTIs). […] A meta-analysis of over 250 articles revealed that the prevalence of reflux was 31.1% in children who were evaluated for a UTI and 17.2% in those with normal kidneys who had VCUG for other indications, such as the diagnosis of hydronephrosis.

• #30 Managing vesicoureteral reflux in children:… | F1000Research

  https://f1000research.com/articles/8-29

  The definition of what constitutes clinically meaningful VUR has developed into the major point of interest when it comes to screening and treatment. […] The concept of delaying VCUG in the workup following febrile UTI is now supported by the American Academy of Pediatrics (AAP) guidelines for patients from 2 to 24 months of age; this is a practice change from the historical workup for febrile UTI. […] The overarching goal of all VUR management is to prevent UTI and renal scarring by using the least invasive means to preserve maximum renal function and prevent hypertension. […] VUR is not thought to cause UTI but potentially decreases the time for progression from cystitis to pyelonephritis. […] Several well-constructed trials have been carried out with the intent to define the role of CAP in the management of VUR, but no concise conclusion could be drawn from the data.

• #31 Periureteral Bulking Agents for the Treatment of Vesicoureteral Reflux (VUR)

  https://www.southcarolinablues.com/web/public/brands/medicalpolicy/external-policies/periureteral-bulking-agents-for-the-treatment-of-vesicoureteral-reflux-vur/

  Treatment of VUR remains controversial. […] There is a lack of good evidence that VUR actually increases the risk of pyelonephritis and renal scarring, and the long period of time before renal scarring, hypertension, and end-stage renal disease makes these serious conditions difficult to study. […] An important challenge is to identify the subset of children most likely to benefit from VUR treatment. […] The use of bulking agents in the treatment of VUR has been reported for more than 20 years and has been suggested as an alternative to antibiotic and surgical therapy. […] The evidence is sufficient to determine that the technology results in a meaningful improvement in the net health outcome. […] The evidence is insufficient to determine the effects of the technology on health outcomes. […] The evidence is sufficient to determine that the technology results in an improvement in the net health outcome. […] The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.

• #32 Endoscopic Management of Complicated Highgrade Vesicoureteral Reflux in the First Year of Life – The Journal of Pediatric Research

  https://jpedres.org/articles/endoscopic-management-of-complicated-highgrade-vesicoureteral-reflux-in-the-first-year-of-life/doi/jpr.galenos.2021.37132

  The management of vesicoureteral reflux (VUR) in infants, whether diagnosed with antenatal hydronephrosis or urinary infections, remains controversial. […] The management of high-grade infantile reflux is still controversial with insufficient data. Published studies comparing endoscopic treatment and antibiotic prophylaxis have inconclusive results due to their wide range of success rates. […] Endoscopic treatment is a successful alternative in infants with high-grade VUR suffering breakthrough infections.

• #33 Therapeutic Management of Children with Vesicoureteral Reflux

  https://www.mdpi.com/2077-0383/13/1/244

  In children without UTI symptoms and with low grades of VUR, the “wait and watch” approach could be considered due to the high probability of spontaneous resolution. […] However, regular follow-up visits are required to enable adequate monitoring of the patient’s status, and this approach is recommended for patients with a relatively low risk of renal injury, such as males with low-grade VUR. […] Conversely, independently from the severity of the VUR, in children with LUTS and recurrent UTIs, continuous antibiotic prophylaxis (CAP) could be prescribed. […] However, randomized trials failed to establish a precise identikit of a child requiring a CAP strategy, suggesting an accurate identification of the risks, personalization of the treatment, and the correct timing of treatment to achieve efficient results.

• #34 Therapeutic Management of Children with Vesicoureteral Reflux

  https://www.mdpi.com/2077-0383/13/1/244

  Lastly, endoscopic and surgical procedures represent alternative options, considering the high rate of resolution of VUR, but there are contrasting data about the incidence of UTI- and VUR-related nephropathy after the procedures. […] According to these data, surgical correction, not modifying the natural history of the disease, is proposed when CAP fails, especially in females with high grades of VUR.

• #35 Vesicoureteral Reflux Market – Global Market – Industry Trends and Forecast to 2028 | Data Bridge Market Research

  https://www.databridgemarketresearch.com/reports/global-vesicoureteral-reflux-market?srsltid=AfmBOoroz4taVqcVJA8fL5fTC9phtL8hw_ejQ3sVEE6Su2YPo6Nl4gk5

  Vesicoureteral reflux market is expected to gain market growth in the forecast period of 2021-2028. […] This disease is most common in infants and young children. […] Rise in the prevalence of urinary tract infection, growing healthcare expenditure, genetic predisposition, development of treatment options, growing government funding, upsurge in the screening procedure, rising awareness are the factors that will expand the vesicoureteral reflux market. […] However, high cost of treatment and complications associated with the vesicoureteral reflux such as constipation, high blood pressure, urinary tract infections and bladder problems are the factors that will hinder the market growth and will further challenge the vesicoureteral reflux market in the forecast period mentioned above. […] Vesicoureteral reflux market also provides you with detailed market analysis for patient analysis, prognosis and cures. Prevalence, incidence, mortality, adherence rates are some of the data variables that are available in the report.

• #36 Managing vesicoureteral reflux in children:… | F1000Research

  https://f1000research.com/articles/8-29

  This study therefore demonstrated the equivalence of medical and surgical therapy; however, the incidence of surgical obstruction reported in the European arm was higher than in the American arm and greater than in many other clinical reports. […] The importance of the management of BBD is emphasized in the 2010 meta-analysis conducted by the American Urological Association, which showed that BBD was associated with higher UTI incidence while on antibiotic prophylaxis, lower rates of resolution of VUR, and reduced success of endoscopic treatment of VUR. […] The goal of reducing the recurrence of acute febrile UTI, renal scarring, and other complications of VUR can be fulfilled through surgery, which can be approached with cystoscopic subureteric injection, open ureteral reimplantation, and minimally invasive approaches such as robot-assisted laparoscopic ureteral reimplantation (RALUR). […] The incorporation of diagnosis and treatment of dysfunctional voiding and constipation into the initial evaluation of the patient could continue to improve the overall outcomes and shape areas of future research.

• #37 World Congress of Pediatric Urology: 1st World Congress of Pediatric Urology Abstracts: IS REAL TIME 3D-ULTRASONOGRAPHY IN SYNOPSIS WITH CLINICAL FOLLOW UP STUDIES A SUFFICIENT TOOL FOR SURVEILLANCE AFTER ENDOSCOPIC TREATMENT OF CHILDREN WITH VESICOURETE

  https://spuonline.org/meeting/abstracts/2010/MP50.cgi

  The endoscopic treatment of vesicoureteral reflux (VUR) in children has become a standard treatment with success rates up to 90%. […] There are still no guidelines for the follow up of these patients. […] 4D-US in synopsis with the clinical course is a sufficient tool in the follow up of children after endoscopic treatment of low grade VUR. […] In case of an orthotopic position of the Deflux depot in the follow up with 4D-US no UTI occurred. So these patients do not need further postoperative investigations. […] With this new diagnostic tool it is possible to identify a shifting of the Deflux depot, indicating the minority of children with a possible treatment failure and persistent VUR. Only these small groups of patients have to undergo further invasive diagnostic with VCUG, which means radiation burden and catheterization.

• #38 Vesicoureteral Reflux | Select 5-Minute Pediatrics Topics

  https://www.unboundmedicine.com/5minute/view/Select-5-Minute-Pediatric-Consult/14167/all/Vesicoureteral_Reflux?q=Reflux+Vesicoureteral

  VUR occurs in ~1% of children. […] In those detected in the postnatal evaluation of an infant with prenatal HN: ~2030% of patients with prenatal HN have VUR. Screening this population for VUR is controversial (see Diagnostic Tests Interpretation section). […] In those detected during imaging evaluation of a UTI: Up to 3050% of children with fUTI will have VUR.

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