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Persistence and recurrence of vesicoureteric reflux in children after endoscopic therapy - implications of a risk-adapted follow-up.

Haid B, Berger C, Roesch J, Becker T, Koen M, Langsteger W, Oswald J - Cent European J Urol (2015)

Bottom Line: There is no well-defined follow-up scheme available to reliably detect persistent or recurrent vesicoureteric reflux (VUR) after endoscopic therapy (ET), but also to reduce postoperative invasive diagnostics in these children.VUR persistence 3 months after ET was found in 11 (11.9%) patients; recurrent VUR in 4 (4.3%) patients.Scarring on preoperative DMSA and dilating VUR (°III and °IV) were significantly associated with recurrent VUR.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Urology, Hospital of the Sisters of Charity, Linz, Austria.

ABSTRACT

Introduction: There is no well-defined follow-up scheme available to reliably detect persistent or recurrent vesicoureteric reflux (VUR) after endoscopic therapy (ET), but also to reduce postoperative invasive diagnostics in these children. Our aim was the evaluation of possible predictors of persistence and recurrence of VUR, in order to elaborate and test a risk-adapted follow-up regimen.

Material and methods: 92 patients (85/92%f, 7/8%m, age 2.99y) underwent direct isotope cystography (DIC) three months after ET. Persistent or recurrent VUR, scarring on dimercaptosuccinic acid (DMSA) scans and further fUTIs after therapy (follow-up 24.6 m) were documented and analysed.

Results: VUR persistence 3 months after ET was found in 11 (11.9%) patients; recurrent VUR in 4 (4.3%) patients. Scarring on preoperative DMSA and dilating VUR (°III and °IV) were significantly associated with recurrent VUR. If only children with preoperative positive DMSA scan or dilating VUR would have undergone DIC, only 58/92 DICs (64%) would have been necessary. Only 45.5% of otherwise detected VURs would have been identified using this risk-adapted strategy.

Conclusions: Limiting invasive follow-up diagnostics (VCUG) and, therewith, the radiation burden in a predefined group of patients at risk for persistence or recurrence of VUR is not recommended, due to the significant chance of missing persistent or new onset contralateral VUR. Therefore, we recommend a routine follow-up VCUG after ET. Further prospective scientific efforts to evaluate new, alternative factors influencing persistence and recurrence of VUR, in order to establish an effective follow-up strategy, are warranted.

No MeSH data available.


Related in: MedlinePlus

VUR grades, systems (%).
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Figure 0001: VUR grades, systems (%).

Mentions: We retrospectively analysed a cohort of 92 patients (85/92% female, 7/8% male, mean age 2.99y) who underwent direct isotope cystography (DIC) after ET of VUR with dextranomer/hyaluronic acid (Dx/HA) at our institution between 2008 and 2013. Patients were referred to DIC for follow-up 3 months after ET of VUR. Patient characteristics and reflux grades are displayed in Table 1 and Figure 1A. Preoperatively all patients were evaluated by conventional VCUG and dimercaptosuccinic acid (DMSA) renal scan to evaluate differential function and possible scar formation. 70% of our patients had low grade (II) VUR (Figure 1A). A DMSA scan revealed postpyelonephritic changes in 39 (42.3%) patients (4 bilateral, 9 right, 26 left). Recurrent febrile urinary tract infections or breakthrough infections were the indications for endoscopic treatment. The probability of having a positive DMSA scan/system (n = 43/136) preoperatively was 10.6% (5/47) for systems without VUR (contralateral), 20% (3/15) for VUR °I, 28.75% (23/80) for VUR °II, 25.64% (10/39) for VUR °III and 66.6% (2/3) for VUR °IV (Figure 1B). Complications and further non-febrile and febrile UTIs were recorded. A VCUG was performed during follow-up of febrile UTIs to detect eventual recurrent VUR.


Persistence and recurrence of vesicoureteric reflux in children after endoscopic therapy - implications of a risk-adapted follow-up.

Haid B, Berger C, Roesch J, Becker T, Koen M, Langsteger W, Oswald J - Cent European J Urol (2015)

VUR grades, systems (%).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4643701&req=5

Figure 0001: VUR grades, systems (%).
Mentions: We retrospectively analysed a cohort of 92 patients (85/92% female, 7/8% male, mean age 2.99y) who underwent direct isotope cystography (DIC) after ET of VUR with dextranomer/hyaluronic acid (Dx/HA) at our institution between 2008 and 2013. Patients were referred to DIC for follow-up 3 months after ET of VUR. Patient characteristics and reflux grades are displayed in Table 1 and Figure 1A. Preoperatively all patients were evaluated by conventional VCUG and dimercaptosuccinic acid (DMSA) renal scan to evaluate differential function and possible scar formation. 70% of our patients had low grade (II) VUR (Figure 1A). A DMSA scan revealed postpyelonephritic changes in 39 (42.3%) patients (4 bilateral, 9 right, 26 left). Recurrent febrile urinary tract infections or breakthrough infections were the indications for endoscopic treatment. The probability of having a positive DMSA scan/system (n = 43/136) preoperatively was 10.6% (5/47) for systems without VUR (contralateral), 20% (3/15) for VUR °I, 28.75% (23/80) for VUR °II, 25.64% (10/39) for VUR °III and 66.6% (2/3) for VUR °IV (Figure 1B). Complications and further non-febrile and febrile UTIs were recorded. A VCUG was performed during follow-up of febrile UTIs to detect eventual recurrent VUR.

Bottom Line: There is no well-defined follow-up scheme available to reliably detect persistent or recurrent vesicoureteric reflux (VUR) after endoscopic therapy (ET), but also to reduce postoperative invasive diagnostics in these children.VUR persistence 3 months after ET was found in 11 (11.9%) patients; recurrent VUR in 4 (4.3%) patients.Scarring on preoperative DMSA and dilating VUR (°III and °IV) were significantly associated with recurrent VUR.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Urology, Hospital of the Sisters of Charity, Linz, Austria.

ABSTRACT

Introduction: There is no well-defined follow-up scheme available to reliably detect persistent or recurrent vesicoureteric reflux (VUR) after endoscopic therapy (ET), but also to reduce postoperative invasive diagnostics in these children. Our aim was the evaluation of possible predictors of persistence and recurrence of VUR, in order to elaborate and test a risk-adapted follow-up regimen.

Material and methods: 92 patients (85/92%f, 7/8%m, age 2.99y) underwent direct isotope cystography (DIC) three months after ET. Persistent or recurrent VUR, scarring on dimercaptosuccinic acid (DMSA) scans and further fUTIs after therapy (follow-up 24.6 m) were documented and analysed.

Results: VUR persistence 3 months after ET was found in 11 (11.9%) patients; recurrent VUR in 4 (4.3%) patients. Scarring on preoperative DMSA and dilating VUR (°III and °IV) were significantly associated with recurrent VUR. If only children with preoperative positive DMSA scan or dilating VUR would have undergone DIC, only 58/92 DICs (64%) would have been necessary. Only 45.5% of otherwise detected VURs would have been identified using this risk-adapted strategy.

Conclusions: Limiting invasive follow-up diagnostics (VCUG) and, therewith, the radiation burden in a predefined group of patients at risk for persistence or recurrence of VUR is not recommended, due to the significant chance of missing persistent or new onset contralateral VUR. Therefore, we recommend a routine follow-up VCUG after ET. Further prospective scientific efforts to evaluate new, alternative factors influencing persistence and recurrence of VUR, in order to establish an effective follow-up strategy, are warranted.

No MeSH data available.


Related in: MedlinePlus