Portal de Periódicos da CAPES

Spontaneous Resolution of Vesicoureteral Reflux: A 15-Year Perspective

2002; Lippincott Williams & Wilkins; Volume: 168; Issue: 6 Linguagem: Inglês

10.1016/s0022-5347(05)64225-5

1527-3792

C. William Schwab, Hsi‐Yang Wu, Heather Selman, Grahame Smith, Howard M. Snyder, Douglas A. Canning,

Urinary Tract Infections Management

No AccessJournal of UrologyPEDIATRIC UROLOGY1 Dec 2002Spontaneous Resolution of Vesicoureteral Reflux: A 15-Year Perspective C. WILLIAM SCHWAB, HSI-YANG WU, HEATHER SELMAN, GRAHAME H.H. SMITH, HOWARD M. SNYDER, and DOUGLAS A. CANNING C. WILLIAM SCHWABC. WILLIAM SCHWAB , HSI-YANG WUHSI-YANG WU , HEATHER SELMANHEATHER SELMAN , GRAHAME H.H. SMITHGRAHAME H.H. SMITH , HOWARD M. SNYDERHOWARD M. SNYDER , and DOUGLAS A. CANNINGDOUGLAS A. CANNING View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64225-5AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The spontaneous resolution rate of vesicoureteral reflux is helpful for determining the need for surgical intervention and the proper followup schedule in patients on antibiotic prophylaxis. We determined the resolution rate by patient rather than by ureter and analyzed the effects of laterality, gender, age and dysfunctional voiding. Materials and Methods: We retrospectively reviewed the records of 179 girls and 35 boys who presented between 1981 and 1984 with urinary tract infection and were diagnosed with primary vesicoureteral reflux. Mean age at presentation was 4.2 years and median followup was 3 years. Of the patients 107 (50%) had bilateral reflux and 60 had dysfunctional voiding. In 146 children (68%) reflux spontaneously resolved during the study. Patients were categorized by the worst grade of reflux, maintained on antibiotic prophylaxis and underwent voiding cystourethrography yearly until reflux resolved. Kaplan-Meier curves were constructed to define the resolution rate. Results: Grades I to III reflux resolved at 13% yearly during the initial 5 years of followup and then at 3.5% yearly during subsequent followup. Grade IV to V reflux resolved at 5% rate yearly. Bilateral reflux resolved more slowly than unilateral reflux and it resolved more rapidly in boys than in girls. Untreated dysfunctional voiding had no effect on overall resolution. Conclusions: Grades I to III primary vesicoureteral reflux diagnosed after urinary tract infection resolve at identical rates and significantly more rapidly than grades IV to V. Early repair of grade IV to V reflux should be considered after age 18 months. References 1 : International system of radiographic grading of vesicoureteric reflux. International Reflux Study in Children. Pediatr Radiol1985; 15: 105. Google Scholar 2 : The outcome of stopping prophylactic antibiotics in older children with vesicoureteral reflux. J Urol2000; 163: 269. Link, Google Scholar 3 : Disappearance of vesicoureteric reflux during long-term prophylaxis of urinary tract infection in children. Br Med J1977; 2: 285. Google Scholar 4 : Vesicoureteral reflux: a comparison of non-surgical and surgical management. Contrib Nephrol1984; 39: 81. Google Scholar 5 : Medical management of mild and moderate vesicoureteral reflux: followup studies of infants and young children. A preliminary report of the Southwest Pediatric Nephrology Study Group. J Urol1992; 148: 1683. Link, Google Scholar 6 : Cessation of vesicoureteral reflux for 5 years in infants and children allocated to medical treatment. J Urol1992; 148: 1662. Link, Google Scholar 7 : Vesicoureteral reflux in infants. Pediatr Nephrol1999; 13: 355. Google Scholar 8 : Outcome at 10 years of severe vesicoureteric reflux managed medically: report of the International Reflux Study in Children. J Pediatr2001; 139: 656. Google Scholar 9 : Pediatric vesicoureteral reflux guidelines panel summary report on the management of primary vesicoureteral reflux in children. J Urol1997; 157: 1846. Link, Google Scholar 10 : Resolution rates of low grade vesicoureteral reflux stratified by patient age at presentation. J Urol1997; 157: 1410. Link, Google Scholar 11 : Disappearance of vesicoureteral reflux in children. Arch Pediatr Adolesc Med1998; 152: 879. Google Scholar 12 : High grade vesicoureteral reflux: analysis of observational therapy. J Urol1990; 144: 537. Link, Google Scholar 13 : A nonsurgical approach to the management of primary vesicoureteral reflux. J Urol1987; 138: 941. Link, Google Scholar 14 : Comprehensive management of dysfunctional voiding. Pediatrics1999; 103: E31. Google Scholar 15 : Unstable bladder activity and the rate of resolution of vesico-ureteric reflux. Contrib Nephrol1984; 39: 238. Google Scholar 16 : Vesicoureteral reflux and videourodynamic studies: results of a prospective study. Urology2000; 55: 939. Google Scholar 17 : The uninhibited bladder in children: effect of treatment on vesicoureteral reflux resolution. Contrib Nephrol1984; 39: 211. Google Scholar From the Division of Pediatric Urology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byShukla A and Kolon T (2022) Douglas Arthur Canning: A TributeJournal of Urology, VOL. 208, NO. 3, (522-525), Online publication date: 1-Sep-2022.Friedmacher F, Colhoun E and Puri P (2018) Endoscopic Injection of Dextranomer/Hyaluronic Acid as First Line Treatment in 851 Consecutive Children with High Grade Vesicoureteral Reflux: Efficacy and Long-Term ResultsJournal of Urology, VOL. 200, NO. 3, (650-655), Online publication date: 1-Sep-2018.Garcia-Roig M, Ridley D, McCracken C, Arlen A, Cooper C and Kirsch A (2018) Vesicoureteral Reflux Index: Predicting Primary Vesicoureteral Reflux Resolution in Children Diagnosed after Age 24 MonthsJournal of Urology, VOL. 197, NO. 4, (1150-1157), Online publication date: 1-Apr-2017.Arlen A, Garcia-Roig M, Weiss A, Leong T, Cooper C and Kirsch A (2015) Vesicoureteral Reflux Index: 2-Institution Analysis and ValidationJournal of Urology, VOL. 195, NO. 4 Part 2, (1294-1299), Online publication date: 1-Apr-2016.Wang H, Gbadegesin R, Foreman J, Nagaraj S, Wigfall D, Wiener J and Routh J (2018) Efficacy of Antibiotic Prophylaxis in Children with Vesicoureteral Reflux: Systematic Review and Meta-AnalysisJournal of Urology, VOL. 193, NO. 3, (963-969), Online publication date: 1-Mar-2015.Alexander S, Arlen A, Storm D, Kieran K and Cooper C (2018) Bladder Volume at Onset of Vesicoureteral Reflux is an Independent Risk Factor for Breakthrough Febrile Urinary Tract InfectionJournal of Urology, VOL. 193, NO. 4, (1342-1346), Online publication date: 1-Apr-2015.Arlen A, Broderick K, Huen K, Leong T, Scherz H and Kirsch A (2018) Temporal Pattern of Vesicoureteral Reflux on Voiding Cystourethrogram Correlates with Dynamic Endoscopic Hydrodistention Grade of Ureteral OrificeJournal of Urology, VOL. 192, NO. 5, (1503-1507), Online publication date: 1-Nov-2014.Minnillo B, Barbosa J, Carvas F, Penna F, Huang L, Ziniel S, Retik A and Nguyen H (2018) Development and Initial Validation of a Disease Specific Quality of Life Survey for Children With Vesicoureteral RefluxJournal of Urology, VOL. 187, NO. 5, (1828-1833), Online publication date: 1-May-2012.Puri P, Kutasy B, Colhoun E and Hunziker M (2012) Single Center Experience with Endoscopic Subureteral Dextranomer/Hyaluronic Acid Injection as First Line Treatment in 1,551 Children with Intermediate and High Grade Vesicoureteral RefluxJournal of Urology, VOL. 188, NO. 4S, (1485-1489), Online publication date: 1-Oct-2012.Cannon G, Arahna A, Graham D, Passerotti C, Silva A, Retik A and Nguyen H (2018) Improvement in Vesicoureteral Reflux Grade on Serial Imaging Predicts ResolutionJournal of Urology, VOL. 183, NO. 2, (709-713), Online publication date: 1-Feb-2010.Copp H, Nelson C, Shortliffe L, Lai J, Saigal C and Kennedy W (2018) Compliance With Antibiotic Prophylaxis in Children With Vesicoureteral Reflux: Results From a National Pharmacy Claims DatabaseJournal of Urology, VOL. 183, NO. 5, (1994-2000), Online publication date: 1-May-2010.Sedberry-Ross S (2018) Editorial CommentJournal of Urology, VOL. 181, NO. 4, (1875-1875), Online publication date: 1-Apr-2009.Shiraishi K, Matsuyama H, Nepple K, Wald M, Niederberger C, Austin C and Cooper C (2018) Validation of a Prognostic Calculator for Prediction of Early Vesicoureteral Reflux Resolution in ChildrenJournal of Urology, VOL. 182, NO. 2, (687-691), Online publication date: 1-Aug-2009.Estrada C, Passerotti C, Graham D, Peters C, Bauer S, Diamond D, Cilento B, Borer J, Cendron M, Nelson C, Lee R, Zhou J, Retik A and Nguyen H (2018) Nomograms for Predicting Annual Resolution Rate of Primary Vesicoureteral Reflux: Results From 2,462 ChildrenJournal of Urology, VOL. 182, NO. 4, (1535-1541), Online publication date: 1-Oct-2009.Smith G (2018) Editorial CommentJournal of Urology, VOL. 182, NO. 4, (1559-1560), Online publication date: 1-Oct-2009.Knudson M, Austin J, McMillan Z, Hawtrey C and Cooper C (2007) Predictive Factors of Early Spontaneous Resolution in Children With Primary Vesicoureteral RefluxJournal of Urology, VOL. 178, NO. 4S, (1684-1688), Online publication date: 1-Oct-2007.Knudson M, Austin J, Wald M, Makhlouf A, Niederberger C and Cooper C (2007) Computational Model for Predicting the Chance of Early Resolution in Children With Vesicoureteral RefluxJournal of Urology, VOL. 178, NO. 4S, (1824-1827), Online publication date: 1-Oct-2007.Mevorach R, Hulbert W, Rabinowitz R, Kennedy W, Kogan B, Kryger J, Caldamone A, Clark W, Kaplan G, Durkee C and Elder J (2018) Results of a 2-Year Multicenter Trial of Endoscopic Treatment of Vesicoureteral Reflux With Synthetic Calcium HydroxyapatiteJournal of Urology, VOL. 175, NO. 1, (288-291), Online publication date: 1-Jan-2006.Puri P, Pirker M, Mohanan N, Dawrant M, Dass L and Colhoun E (2018) Subureteral Dextranomer/Hyaluronic Acid Injection as First Line Treatment in the Management of High Grade Vesicoureteral RefluxJournal of Urology, VOL. 176, NO. 4S, (1856-1860), Online publication date: 1-Oct-2006.KOBELT G, CANNING D, HENSLE T and LÄCKGREN G (2018) The Cost-Effectiveness of Endoscopic Injection of Dextranomer/Hyaluronic Acid Copolymer for Vesicoureteral RefluxJournal of Urology, VOL. 169, NO. 4, (1480-1485), Online publication date: 1-Apr-2003. Volume 168Issue 6December 2002Page: 2594-2599 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.Keywordsremission, spontaneousureterurinary tract infectionsvesico-ureteral refluxbladderMetricsAuthor Information C. WILLIAM SCHWAB More articles by this author HSI-YANG WU More articles by this author HEATHER SELMAN Financial interest and/or other relationship with Pharmacia and Upjohn. More articles by this author GRAHAME H.H. SMITH More articles by this author HOWARD M. SNYDER More articles by this author DOUGLAS A. CANNING More articles by this author Expand All Advertisement PDF downloadLoading ...