How the Outcome of Infants with Low and Moderate Risks of Vesicoureteral Reflux Differs when They are Managed Conservatively or Operated?

Year 2020, Volume: 73 Issue: 1, 60 - 64, 13.05.2020

Burak Çıtamak

Abstract

Objectives: To compare the resolution of reflux after surgery and follow-up and to determine what the appropriate treatment is in patients with
vesicoureteral reflux (VUR) who were diagnosed less than 2 years of age.

Materials and Methods: Data from 250 patients who were diagnosed with VUR below 2 years of age between 2000 and 2016 were examined
retrospectively. Patients with low risk and moderate risks according to the EAU/ESPU guidelines were evaluated. Patients who underwent surgery
and followed up were compared regarding the age at diagnosis, VCUG findings, gender, presence of scar in DMSA, BTI, postoperative UTI, follow-up
period and resolution rates.

Results: Of the patients, 207 patients underwent surgery while 43 did not. Mean age was 9.62 (0-24) months. Follow-up patients were followed up
for an average of 55.4 months. Of the followed-up patients, 60.5% (26) had complete resolution of VUR at the average of 25.8 months (6-64). When
we compared the data of surgically treated and followed-up patients, we detected that frequency of male gender, renal scar, high-grade reflux and
moderate risk were significantly more, the resolution rate was higher and follow-up period was shorter in operated group.

Conclusion: Spontaneous resolution rate of VUR less than 2 years of age is high and it is important to determine which patients should undergo
early surgery in this patient group in terms of preventing complications. Surgical options with satisfactory success rates should be discussed with
the family. Besides, the possible costs and comorbidities should also be regarded.

Keywords

Vesico-ureteral Reflux , Ureteroneocystostomy , Subureteric Injection , Urinary Tract Infections

Project Number

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Düşük ve Orta Riskli Vezikoüreteral Reflüsü Olan Çocukların Takip veya Opere Edildiğindeki Sonuçları Nasıldır?

Abstract

Amaç: İki yaş altı tanı konan vezikoüreteral reflü (VUR) hastalarında cerrahi ve takip hastalarının başarılarını karşılaştırarak, bu hasta grubunda
uygun tedavinin ne olduğunu ortaya koymaktır.

Gereç ve Yöntem: 2000-2016 tarihleri arasında 2 yaş altında VUR tanısı olan, EAU/ESPU kılavuzlarına göre düşük ve orta riskli olan ve tüm datasına
ulaşılan 250 hastanın verileri retrospektif olarak incelendi. Hastaların tanı anındaki yaşları, VCUG verileri, cinsiyeti, DMSA bulgularında skar olup
olmadığı, araya giren enfeksiyon, postoperatif idrar yolu enfeksiyonu, takip süreleri ve başarıları karşılaştırıldı.

Bulgular: Hastaların 43’ü cerrahi işlem olmadan takip edilmiş, 207’si ise cerrahi işlem geçirmiştir. Hastaların ortalama yaşı 9,62 (0-24) ay bulundu.
Takip hastaları ortalama 55,4 ay takip edildi. Takipteki hastaların %60,5’inde (26) VUR ortalama 25,8 ayda (6-64) tam rezolüsyona uğradı. Cerrahi
olarak tedavi edilen ve takip edilen hastaların verilerini karşılaştırıldığında, opere edilen grupta, erkek cinsiyet, böbrek skarı, yüksek dereceli reflü ve
orta risk varlığının anlamlı derecede daha fazla olduğu, reflünün çözünme oranının yüksek olduğu ve takip süresinin daha kısa olduğu tespit edildi.

Sonuç: İki yaş altında VUR tanısı alan hastaların spontan rezolüsyon oranı yüksek olup, bu hasta grubunda hangi hastanın erken dönemde cerrahi
girişim yapılması gerektiği komplikasyonları önleme açısından önemlidir. Cerrahi seçenek ise tatmin edici başarı oranları ile mutlaka aile ile tartışılmalı
ancak olası maliyet ve komorbiditeleri de unutulmamalıdır.

Keywords

Vezikoüreteral Reflü , Üreteroneosistostomi , Subüreterik Enjeksiyon , Idrar Yolu Enfeksiyonu

Ethical Statement

Ethics Committee Approval: This study is approved by Hacettepe University Ethics Committee (GO-17/106).

Supporting Institution

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Project Number

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Thanks

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