1. Primary vesico-ureteric reflux: The need for individualised risk stratification
- Author
-
Guy Hidas, Maryellen Pribish, Blake Watts, Antoine E. Khoury, Tandis Soltani, and Alexander Nam
- Subjects
Pediatrics ,medicine.medical_specialty ,VCUG, voiding cysto-urethrography ,Dimercaptosuccinic acid (DMSA) ,Urology ,Urinary system ,Renal scars ,Voiding cysto-urethrography ,Prospective data ,BBD, bladder and bowel dysfunction ,urologic and male genital diseases ,Pediatric Urology Review ,Vesico-ureteric reflux ,Medicine ,Antibiotic prophylaxis ,Urinary tract infection ,US, ultrasonography ,business.industry ,Reflux ,Continuous antibiotic prophylaxis ,CAP, continuous antibiotic prophylaxis ,RCT, randomised control trial ,female genital diseases and pregnancy complications ,Risk stratification ,Presentation (obstetrics) ,business ,Bladder and bowel dysfunctions ,Ureteric reflux - Abstract
The management of paediatric primary vesico-ureteric reflux (VUR) has undergone serial changes over the last decade. As this disorder is extremely heterogeneous, and high-quality prospective data are limited, the treatment strategies vary among centres. Current treatment options include observation only, continuous antibiotic prophylaxis, and surgery. Surgical intervention is indicated if a child has a breakthrough urinary tract infection (UTI) while on continuous antibiotic prophylaxis or if there are renal scars present. After excluding a secondary cause of VUR the physician should consider the risk factors affecting the severity of VUR and manage the child accordingly. Those factors include demographic factors (age at presentation, gender, ethnicity) and clinical factors (VUR grade, unilateral vs. bilateral, presence of renal scars, initial presentation, the number of UTIs, and presence of any voiding or bowel dysfunction). In this review we summarise the major controversial issues in current reports on VUR and highlight the importance of individualised patient management according to their risk stratification. © 2012 Arab Association of Urology. Production and hosting by Elsevier B.V. All rights reserved.
- Published
- 2013
- Full Text
- View/download PDF