Downgrading of high-grade vesicoureteral reflux is a reliable option in the treatment of children with grade IV-V reflux accompanied by breakthrough infections

作者：Kocherov Stanislav; Abu Arafeh Wael; Zeldin Alexander; Ostrovsky Israel A; Ioscovich Alexander; Farkas Amicur; Chertin Boris^*

来源：Journal of Pediatric Urology, 2013, 9(2): 212-216.

DOI：10.1016/j.jpurol.2012.02.006

• High-grade VUR
• Endoscopic treatment
• Downgrade VUR, long-term follow-up
• Renal scarring
• UTI

Purpose: To evaluate incidence of urinary tract infection (UTI) and natural history of downgraded vesicoureteral reflux (VUR) in children with high-grade VUR following endoscopic correction.
Materials and methods: We retrospectively studied 54 children (13 males and 41 females) with a mean age of 1.8 years who underwent endoscopic correction of Grade IV-V VUR due to breakthrough infections while on antibiotic prophylaxis. Reflux was Grade IV in 40 (74%) and V in 14 (26%) patients comprising 95 renal refluxing units (RRU). Reflux was corrected in 72 (76%) RRU. 18 (34%) patients/23 (24%) RRU demonstrated downgrading of VUR. 21 of the 23 RRU showed Grade II and 2 Grade III VUR, and were taken off antibiotic prophylaxis and allocated to observation. Patients were followed for 2-22 years (median 14 years).
Results: Technetium 99m dimercaptosuccinic acid renal scan demonstrated preoperative renal scarring in 21 (78%) of the 23 RRU with downgraded VUR. None of the children developed febrile UTI after surgery. 1 RRU showed renal function deterioration. 8 (44%) of the 18 patients underwent follow-up voiding cystourethrogram, and in 7 (88%) there was either spontaneous resolution of VUR or downgrade to Grade I VUR.
Conclusions: Downgrading of VUR is a reasonable option in patients with high-grade VUR suffering from breakthrough infections while on antibiotic prophylaxis. It leads to the cessation of febrile UTIs, further spontaneous resolution of VUR and may potentially avoid renal damage.

• 出版日期2013-4