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Primary Bilateral High-Grade Vesicoureteral Reflux in Children: Management Perspective
Objective Vesicoureteral reflux (VUR) is a common finding in the pediatric population with the risk of repeated infections and renal damage. There is little is known about the natural history of primary bilateral high-grade reflux. Herein we present our experience in the management of primary high-g...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cureus
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834586/ https://www.ncbi.nlm.nih.gov/pubmed/33520484 http://dx.doi.org/10.7759/cureus.12266 |
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author | Al Qahtani, Wadha Sarhan, Osama Al Otay, Abdulhakim El Helaly, Ahmed Al Kawai, Fouad |
author_facet | Al Qahtani, Wadha Sarhan, Osama Al Otay, Abdulhakim El Helaly, Ahmed Al Kawai, Fouad |
author_sort | Al Qahtani, Wadha |
collection | PubMed |
description | Objective Vesicoureteral reflux (VUR) is a common finding in the pediatric population with the risk of repeated infections and renal damage. There is little is known about the natural history of primary bilateral high-grade reflux. Herein we present our experience in the management of primary high-grade bilateral VUR and the long-term outcome of renal function in this specific group of patients. Materials and methods We retrospectively evaluated all patients with congenital bilateral VUR between 2006 and 2014. Records were reviewed for patient age at diagnosis, antenatal history, clinical presentation, the grade of VUR on voiding cystourethrogram (VCUG), presence of scars on dimercaptosuccinic acid (DMSA) scan, indications for surgical intervention, and surgical approaches. Clinical and radiological outcomes of this subgroup of patients were assessed. Results A total of 67 patients with bilateral VUR were identified, of whom 31 (20 boys and 11 girls) had primary high-grade (grade IV and V) bilateral VUR. The mean age at diagnosis was seven months. DMSA scans showed renal scars in 19 patients (61%) and eight of them were bilateral. Surgical intervention was necessary for 81% of patients with a success rate of 58% after endoscopic correction and 100% after reimplantation. Chronic kidney disease (CKD) developed in 13 patients (42%) after a mean follow-up of eight years. Conclusions Primary bilateral high-grade VUR carries a high rate of surgical intervention. The endoscopic correction has an acceptable success rate and efficient long-term outcome. Nevertheless, a significant proportion of patients progresses to CKD even after VUR management. |
format | Online Article Text |
id | pubmed-7834586 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Cureus |
record_format | MEDLINE/PubMed |
spelling | pubmed-78345862021-01-28 Primary Bilateral High-Grade Vesicoureteral Reflux in Children: Management Perspective Al Qahtani, Wadha Sarhan, Osama Al Otay, Abdulhakim El Helaly, Ahmed Al Kawai, Fouad Cureus Urology Objective Vesicoureteral reflux (VUR) is a common finding in the pediatric population with the risk of repeated infections and renal damage. There is little is known about the natural history of primary bilateral high-grade reflux. Herein we present our experience in the management of primary high-grade bilateral VUR and the long-term outcome of renal function in this specific group of patients. Materials and methods We retrospectively evaluated all patients with congenital bilateral VUR between 2006 and 2014. Records were reviewed for patient age at diagnosis, antenatal history, clinical presentation, the grade of VUR on voiding cystourethrogram (VCUG), presence of scars on dimercaptosuccinic acid (DMSA) scan, indications for surgical intervention, and surgical approaches. Clinical and radiological outcomes of this subgroup of patients were assessed. Results A total of 67 patients with bilateral VUR were identified, of whom 31 (20 boys and 11 girls) had primary high-grade (grade IV and V) bilateral VUR. The mean age at diagnosis was seven months. DMSA scans showed renal scars in 19 patients (61%) and eight of them were bilateral. Surgical intervention was necessary for 81% of patients with a success rate of 58% after endoscopic correction and 100% after reimplantation. Chronic kidney disease (CKD) developed in 13 patients (42%) after a mean follow-up of eight years. Conclusions Primary bilateral high-grade VUR carries a high rate of surgical intervention. The endoscopic correction has an acceptable success rate and efficient long-term outcome. Nevertheless, a significant proportion of patients progresses to CKD even after VUR management. Cureus 2020-12-25 /pmc/articles/PMC7834586/ /pubmed/33520484 http://dx.doi.org/10.7759/cureus.12266 Text en Copyright © 2020, Al Qahtani et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Urology Al Qahtani, Wadha Sarhan, Osama Al Otay, Abdulhakim El Helaly, Ahmed Al Kawai, Fouad Primary Bilateral High-Grade Vesicoureteral Reflux in Children: Management Perspective |
title | Primary Bilateral High-Grade Vesicoureteral Reflux in Children: Management Perspective |
title_full | Primary Bilateral High-Grade Vesicoureteral Reflux in Children: Management Perspective |
title_fullStr | Primary Bilateral High-Grade Vesicoureteral Reflux in Children: Management Perspective |
title_full_unstemmed | Primary Bilateral High-Grade Vesicoureteral Reflux in Children: Management Perspective |
title_short | Primary Bilateral High-Grade Vesicoureteral Reflux in Children: Management Perspective |
title_sort | primary bilateral high-grade vesicoureteral reflux in children: management perspective |
topic | Urology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834586/ https://www.ncbi.nlm.nih.gov/pubmed/33520484 http://dx.doi.org/10.7759/cureus.12266 |
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