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High Grade Vesicoureteral Reflux: Analysis of Observational Therapy

1990; Lippincott Williams & Wilkins; Volume: 144; Issue: 2 Part 2 Linguagem: Inglês

10.1016/s0022-5347(17)39516-2

1527-3792

Gordon A. McLorie, Patrick H. McKenna, Brian Jumper, Bernard M. Churchill, Robert F. Gilmour, Antoine E. Khoury,

Ureteral procedures and complications

No AccessJournal of Urology1 Aug 1990High Grade Vesicoureteral Reflux: Analysis of Observational Therapy Gordon A. McLorie, Patrick H. McKenna, Brian M. Jumper, Bernard M. Churchill, Robert F. Gilmour, and Antoine E. Khoury Gordon A. McLorieGordon A. McLorie , Patrick H. McKennaPatrick H. McKenna , Brian M. JumperBrian M. Jumper , Bernard M. ChurchillBernard M. Churchill , Robert F. GilmourRobert F. Gilmour , and Antoine E. KhouryAntoine E. Khoury View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)39516-2AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Between 1981 and 1987, 300 patients with high grade (III, IV and V international classification) vesicoureteral reflux were treated at a single pediatric hospital. Only patients with primary vesicoureteral reflux were included in the study. The guiding principle during this period was that all patients with high grade vesicoureteral reflux would be observed on prophylactic antibiotics (observational therapy) and surgical correction would be reserved for specific indications. Of the 300 patients 132 received observational therapy alone and 168 required surgical correction for specific indications after varying periods of observation. In both groups the duration of persistent reflux was analyzed using a life-table method. In patients with grade V reflux we observed resolution in 3 patients whereas 23 required surgical correction. Of those patients in the observation group with grade IV reflux 83% had persistent reflux at 2 years and 70% still had reflux at 5 years. For those with grade III reflux the persistence rate was 83% and 50%, respectively. Neither age, sex nor side of reflux had a correlation with the rate of resolution. When tested grade of reflux correlated loosely (p = 0.07). During the period of observational therapy new renal scars developed in 23 patients (8%). We conclude that high grade vesicoureteral reflux can resolve in a minority of patients over a protracted interval. On the basis of this analysis, we advocate consideration of surgical correction in these patients after a 4-year period of observational therapy and for specific indications. © 1990 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByPohl H, Joyce G, Wise M and Cilento B (2018) Vesicoureteral Reflux and UreterocelesJournal of Urology, VOL. 177, NO. 5, (1659-1666), Online publication date: 1-May-2007.Yeung C, Sreedhar B, Sihoe J and Sit F (2018) Renal and Bladder Functional Status at Diagnosis as Predictive Factors for the Outcome of Primary Vesicoureteral Reflux in ChildrenJournal of Urology, VOL. 176, NO. 3, (1152-1157), Online publication date: 1-Sep-2006.AL-SAYYAD A, PIKE J and LEONARD M (2018) CAN PROPHYLACTIC ANTIBIOTICS SAFELY BE DISCONTINUED IN CHILDREN WITH VESICOURETERAL REFLUX?Journal of Urology, VOL. 174, NO. 4 Part 2, (1587-1589), Online publication date: 1-Oct-2005.CHERTIN B, DE CALUWÉ D and PURI P (2018) Endoscopic Treatment of Primary Grades IV and V Vesicoureteral Reflux in Children With Subureteral Injection of PolytetrafluoroethyleneJournal of Urology, VOL. 169, NO. 5, (1847-1849), Online publication date: 1-May-2003.SCHWAB C, WU H, SELMAN H, SMITH G, SNYDER H and CANNING D (2018) Spontaneous Resolution of Vesicoureteral Reflux: A 15-Year PerspectiveJournal of Urology, VOL. 168, NO. 6, (2594-2599), Online publication date: 1-Dec-2002.HERZ D, HAFEZ A, BAGLI D, CAPOLICCHIO G, McLORIE G and KHOURY A (2018) EFFICACY OF ENDOSCOPIC SUBURETERAL POLYDIMETHYLSILOXANE INJECTION FOR TREATMENT OF VESICOURETERAL REFLUX IN CHILDREN: A NORTH AMERICAN CLINICAL REPORTJournal of Urology, VOL. 166, NO. 5, (1880-1886), Online publication date: 1-Nov-2001.THOMPSON R, CHEN J, PUGACH J, NASEER S and STEINHARDT G (2018) CESSATION OF PROPHYLACTIC ANTIBIOTICS FOR MANAGING PERSISTENT VESICOURETERAL REFLUXJournal of Urology, VOL. 166, NO. 4, (1465-1469), Online publication date: 1-Oct-2001.SWEENEY B, CASCIO S, VELAYUDHAM M and PURI P (2018) REFLUX NEPHROPATHY IN INFANCY: A COMPARISON OF INFANTS PRESENTING WITH AND WITHOUT URINARY TRACT INFECTIONJournal of Urology, VOL. 166, NO. 2, (648-650), Online publication date: 1-Aug-2001.HERNDON C, FERRER F and McKENNA P (2018) SURVEY RESULTS ON MEDICAL AND SURGICAL FOLLOWUP OF PATIENTS WITH VESICOURETERAL REFLUX FROM AMERICAN ASSOCIATION OF PEDIATRICS, SECTION ON UROLOGY MEMBERSJournal of Urology, VOL. 165, NO. 2, (559-563), Online publication date: 1-Feb-2001.FARHAT W, McLORIE G, GEARY D, CAPOLICCHIO G, BÄGLI D, MERGUERIAN P and KHOURY A (2018) THE NATURAL HISTORY OF NEONATAL VESICOURETERAL REFLUX ASSOCIATED WITH ANTENATAL HYDRONEPHROSISJournal of Urology, VOL. 164, NO. 3 Part 2, (1057-1060), Online publication date: 1-Sep-2000.COOPER C, CHUNG B, KIRSCH A, CANNING D and SNYDER H (2018) THE OUTCOME OF STOPPING PROPHYLACTIC ANTIBIOTICS IN OLDER CHILDREN WITH VESICOURETERAL REFLUXJournal of Urology, VOL. 163, NO. 1, (269-273), Online publication date: 1-Jan-2000.Greenfield S, Ng M and Wan J (2018) Resolution Rates of Low Grade Vesicoureteral Reflux Stratified by Patient Age at PresentationJournal of Urology, VOL. 157, NO. 4, (1410-1413), Online publication date: 1-Apr-1997.Wan J, Greenfield S, Talley M and Ng M (2018) An Analysis of Social and Economic Factors Associated with Followup of Patients With Vesicoureteral RefluxJournal of Urology, VOL. 156, NO. 2S, (668-672), Online publication date: 1-Aug-1996.Haraoka M, Matsumoto T, Takahashi K, Kubo S, Tanaka M and Kumazawa J (2018) Suppression of Renal Scarring by Prednisolone Combined with Ciprofloxacin in Ascending Pyelonephritis in RatsJournal of Urology, VOL. 151, NO. 4, (1078-1080), Online publication date: 1-Apr-1994.Houle A, McLorie G, Heritz D, McKenna P, Churchill B and Khoury A (2018) Extravesical Nondismembered Ureteroplasty with Detrusorrhaphy: A Renewed Technique to Correct Vesicoureteral Reflux in ChildrenJournal of Urology, VOL. 148, NO. 2 Part 2, (704-707), Online publication date: 1-Aug-1992.Elder J, Snyder H, Peters C, Arant B, Hawtrey C, Hurwitz R, Parrott T and Weiss R (2018) Variations in Practice among Urologists and Nephrologists Treating Children with Vesicoureteral RefluxJournal of Urology, VOL. 148, NO. 2 Part 2, (714-717), Online publication date: 1-Aug-1992.Perli Goldraich N and Goldraich I (2018) Followup of Conservatively Treated Children with High and Low Grade Vesicoureteral Reflux: A Prospective StudyJournal of Urology, VOL. 148, NO. 5 Part 2, (1688-1692), Online publication date: 1-Nov-1992. Volume 144Issue 2 Part 2August 1990Page: 537-540 Advertisement Copyright & Permissions© 1990 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Gordon A. McLorie More articles by this author Patrick H. McKenna More articles by this author Brian M. Jumper More articles by this author Bernard M. Churchill More articles by this author Robert F. Gilmour More articles by this author Antoine E. Khoury More articles by this author Expand All Advertisement Loading ...