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A Journal on Nephrology and Urology

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Minerva Urologica e Nefrologica 2002 December;54(4):227-32

language: Italian

Predicting factors of vesicoureteral evolution in children

Chiaramonte C., Cigna R. M., Siracusa F., Castro L., Cataliotti F.

Clinica Chirurgica Pediatrica Università degli Studi di Palermo, Palermo


Back­ground. ­Despite the ­large num­ber of chil­dren ­with ­reflux, man­age­ment ­among urol­o­gists is ­still con­tro­ver­sial. One of the ­most debat­ed ­aspects is the ­choice ­between obser­va­tion treat­ment or sur­gi­cal treat­ment.
Meth­ods. We ­assessed the nat­u­ral ­course of chil­dren ­with ves­i­co-uret­er­al ­reflux in the peri­od 1990-1995, to cor­re­late fac­tors and iden­ti­fy ­patients ­with ­high ­risk of ­renal dam­age. We ret­ro­spec­tive­ly ­reviewed the clin­i­cal ­course of 80 chil­dren ­with ves­i­cou­ret­er­al ­reflux. Thir­ty-two ­were diag­nosed dur­ing pre­na­tal ultra­sound ­scan. In the oth­er cas­es uro­log­ic eval­u­a­tion was request­ed ­because of uri­nary ­tract infec­tions. The fol­low­ing ­data ­were ana­lyzed: med­i­cal ­records, diag­nos­tic and fol­low-up cys­to­gram, ­renal imag­ing, med­i­cal ther­a­py or sur­gi­cal treat­ment car­ried out accord­ing to the ­reflux ­grade, diag­nos­tic age, con­gen­i­tal ­reflux neph­rop­a­thy or post­na­tal ­acquired scar­ring, void­ing pat­terns, spon­ta­ne­ous res­o­lu­tion dur­ing med­i­cal man­age­ment. Fol­low up ­ranged ­from 5 to 10 ­years.
­Results. Ves­i­cou­ret­er­al ­reflux ­resolved spon­ta­ne­ous­ly in 29 ­patients: 25 ­were affect­ed ­from mod­er­ate ­reflux, 4 ­from IV ­grade ­reflux. Sur­gi­cal cor­rec­tion was car­ried out in 32 ­patients. Endo­scop­ic treat­ment was per­formed in 25. Twen­ty-two chil­dren are ­still receiv­ing pro­phy­lax­is and 12 ­were ­lost to fol­low-up. Con­gen­i­tal ­renal pathol­o­gy cor­re­late ­with ­poor out­come.
Con­clu­sions. The con­clu­sion is ­drawn ­that ­there is a ­wide clin­i­cal var­i­abil­ity in chil­dren ­with ves­ci­cou­ret­er­al ­reflux. The ­most impor­tant is ­host’s sus­cep­ti­bil­ity to uri­nary ­tract infec­tion, but the sever­ity of ­reflux, age of ­patients and con­gen­i­tal ­reflux neph­rop­a­thy influ­ence prog­no­sis and ­long-­term out­come.

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