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. 2023 Dec 31;13(1):244.
doi: 10.3390/jcm13010244.

Therapeutic Management of Children with Vesicoureteral Reflux

Valeria Chirico  1 , Filippo Tripodi  1 , Antonio Lacquaniti  2 , Paolo Monardo  2 , Giovanni Conti  1 , Giorgio Ascenti  3 , Roberto Chimenz  1
Affiliations

Therapeutic Management of Children with Vesicoureteral Reflux

Valeria Chirico et al. J Clin Med. .

Abstract

Contrasting data refer to therapies for vesicoureteral reflux (VUR), such as surgical treatments and continuous antibiotic prophylaxis (CAP). This study evaluated the effectiveness of these approaches in children with VUR, analyzing the recurrence of febrile urinary tract infections (UTIs) and the resolution of VUR after the treatment. A total of 350 pediatric patients underwent contrast-enhanced voiding urosonography (ceVUS) to diagnose a VUR, whereas renal scintigraphy evaluated potential scars. After 12 months from the treatment, the VUR, the relapse of febrile UTIs, and reflux-related nephropathy were analyzed. Twenty-seven children had recurrent febrile UTIs after surgical therapy, with a greater rate of relapses observed in III and V VUR grades. Thirteen patients who underwent surgery had scars, independently of VUR grades and gender, with evidence of chronic renal failure at the end of the follow-up period. A total of 140 subjects were treated with CAP, and 30% of them continued to suffer from febrile UTIs. Ninety-five patients with VUR underwent ceVUS after 12 months, with persistent reflux in fifty-two patients. All of them had severe VUR, correlating with the age at diagnosis and gender. CAP therapy prevented scarring better than surgery, especially in children with III and V grades of VUR. A late onset of VUR or VUR involving neonatal patients is rarely a reversible process. This study identified predictors of success or failure of surgical or CAP therapies, evaluating the relapse of UTIs or persistent reflux after the treatment and giving prognostic information in children with VUR.

Keywords: continuous antibiotic prophylaxis (CAP); contrast-enhanced voiding urosonography (ceVUS); febrile urinary tract infection (UTI); renal scars; vesicoureteral reflux (VUR).

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Inclusion and exclusion criteria and therapeutic strategies. Abbreviations: CAKUT: congenital anomalies of the kidney and urinary tract; IS: ultrasound; UTIs: urinary tract infections; LUTS: lower urinary tract symptoms; ceVUS: contrast-enhanced voiding urosonography; VCUG: voiding cystourethrogram; VUR: vesicoureteral reflux; CAP: continuous antibiotic prophylaxis.
Figure 2
Figure 2
Febrile UTI relapse after surgical therapy according to VUR grades. *: p < 0.05.
Figure 3
Figure 3
CAP therapy and renal scarring during the follow-up period. *: p < 0.05. Males had renal scarring prevention in grade V of VUR (A), whereas females with grades III and IV of VUR obtained more scarring prevention (B) after CAP therapy.
Figure 4
Figure 4
Persistent reflux after a follow-up of 12 months.
Figure 5
Figure 5
Febrile UTI post surgery: risk profiles. Abbreviations: UTI: urinary tract infection; VUR: vesicoureteral reflux; fUTI: febrile urinary tract infection; BBD: bladder and bowel dysfunction.
Figure 6
Figure 6
Febrile UTI post CAP: risk profiles. Abbreviations: UTI: urinary tract infection; VUR: vesicoureteral reflux; fUTI: febrile urinary tract infection; BBD: bladder and bowel dysfunction.
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