Primary vesicoureteric reflux in 72 children

Abstract

Objective To summarize the treatment and prognosis of children with primary vesicoureteric reflux (PVUR) and the correlation between PVUR and urinary tract infections(UTI). Methods The children with PVUR (72 cases) who were hospitalized at the Department of Nephrology and Urology of Children′s Hospital Affiliated to Capital Institute of Pediatrics from June 2007 to April 2018 were selected, and the clinical manifestations were summarized. Results A total of 72 patients (52 boys, 20 girls) were involved, and the median age at diagnosis was 8 months, in which 44 cases (61.1%) were less than 1 year old.There were 55 cases with UTI onset (76.4%), 94.5%(52/55 cases) with recurrent UTI(twice or more than twice) and 2 cases (2.8%) ended with renal failure.Refluxes were unilateral in 34 patients and bilateral in 38 patients.There were 110 ureters, in which 74 reflux ureters (67.3%) were identified as low-grade (Ⅰ-Ⅲ) PVUR, and 36 reflux ureters(32.7%) were high-grade (Ⅳ-Ⅴ) PVUR.Forty patients received conservative treatment, and significant differences of the remission rate were observed between group Ⅰ-Ⅱ grade PVUR(72.2%, 13/18 cases) and group Ⅲ-Ⅴ grade PVUR(32.5%, 13/40 cases)(χ2=7.92, P=0.005). Twenty-two patients (35 reflux ureters) underwent surgical treatment, in which 31 ureters were cured, and the remission rate was 88.6%.Ten patients with refluxes grade Ⅲ or above had no improvement after medical treatment, but the reflux was completely relieved after surgical treatment. Conclusions Children with recurrent UTI, especially less than 1 year-old, should be considered with PVUR.The conservative treatment could be prior for the patients with Ⅰ-Ⅱ grade PVUR.The surgical treatment could be chosen for those patients who suffered from high-grade PVUR, bilateral reflux or failed conservative treatment, especially with recurrent UTI, and reflux nephropathy could be reduced then. Key words: Vesicoureteric reflux; Urinary tract infection; Child