Abordarea clinică a copiilor cu reflux vezico-ureteral – prezentare generală

Abstract

Vesicoureteral reflux is the most common urinary tract ab­nor­ma­lity among children, estimated to be present in ap­pro­xi­mately 1-2% of them. There are various possibilities of evolution, from asymptomatic forms with spontaneous re­mis­sion to recurrent acute pyelonephritis, reflux ne­phro­pathy, or even end-stage chronic kidney disease. Therefore, the early diagnosis, with a correct staging, is essential, al­lo­w­ing the optimal therapeutic approach. The most com­mon clinical situations requiring imaging investigation of vesi­coureteral reflux are repeated urinary tract infections, fetal hydronephrosis, familial vesicoureteral reflux, blad­der bowel dysfunction, and complex uropathies. The the­ra­peu­tic management is decided according to the reflux se­ve­rity, the clinical manifestations, and the pa­tient’s age. The main objectives of the treatment are to pre­vent uri­na­ry tract infections, the development of renal scars, and the progression toward chronic kidney disease. The the­ra­peu­tic approach may involve active follow-up, con­ti­nuous antibiotic prophylaxis, or surgical intervention. Ac­tive follow-up applies to asymptomatic patients with an in­creased likelihood of spontaneous remission. Antibiotic pro­phy­laxis is the most frequently adopted approach, used in patients with previous urinary tract infections and high-grade reflux. The surgical approach is reserved for cases with a low probability of spontaneous remission and for those with unfavorable evolution under conservative treat­ment. The surgical methods used are represented by en­do­sco­pic injection of an antireflux substance, classical or robotically assisted surgery, with similar success rates. Cur­rently, there is no consensus regarding the therapeutic ap­proach to these patients, the pediatrician being the one who must evaluate each case and propose and in­di­vi­dua­l­ized therapeutic management adapted to the needs of each patient.