The impact of vesicoureteral reflux treatment on the incidence of urinary tract infection |
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Authors: | George M Wadie Kevin P Moriarty |
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Institution: | (1) Pediatric Surgery, Sacred Heart Medical Center, 3377 Riverbend Drive, Springfield, OR 97477, USA;(2) Pediatric Surgery, Baystate Children Hospital, Springfield, MA, USA |
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Abstract: | Vesicoureteral reflux (VUR) is a heterogeneous disease and its management remains one of the most controversial topics in
pediatrics. Management options include surveillance, antibiotics, and surgery. The approval of dextranomer/hyaluronic acid
(DHA) as a bulking agent by the Food and Drug Administration was followed by wide acceptance of endoscopic techniques as a
major tool in the management of reflux. Pyelonephritis rather than VUR is the most common cause of kidney damage in children.
It should be emphasized that the primary goal of diagnosing and treating VUR should be preventing this complication. There
are no sufficient data in the literature to address the impact of the different treatment modalities on the incidence of febrile
urinary tract infections (feb-UTIs) denoting pyelonephritis, with very few studies evaluating endoscopic treatment in light
of this clear and well-defined outcome. The fact that we can correct the anatomy at the vesicoureteral junction with a simple
and relatively safe outpatient procedure does not justify offering it to all patients. In this review, we attempt to critically
evaluate the available literature pertaining to the impact of different treatment modalities on reducing the incidence of
febrile UTIs and kidney damage, with a special emphasis on endoscopic treatment. |
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