Revisiting the EAU Paediatric Urology Guideline Risk Grouping On Vesicoureteral Reflux: Shall We Challenge Ourselves?

İyimser Üre ,Serhat Gürocak ,Özgür Tan ,İrfan Atay ,Cenk Acar ,Esat Ak ,Zafer Sınık

doi:10.12996/gmj.2016.57

Abstract

Objective : To challenge retrospectively the treatment outcomes of vesicoureteral reflux (VUR) management according to new EAU Paediatric Urology Guideline Risk Grouping on VUR. Methods: The records of the patients who received medical and/or surgical treatment between 2009-2012 due to VUR were reviewed. History, demographic variables, diagnostic features (presence of renal scar, grade of reflux, laterality), clinical course, causes of failure, secondary intervention type and follow-up variables were analyzed. The patients were classified as low, moderate and high-risk groups according to EAU paediatric urology guideline. Treatment failure is defined as new urinary tract infection and presence of new renal scar during follow-up. Results: A total of 157 patients with 232 renal units (RU) were treated due to VUR. 33(71.7%) of 46RU’s were treated with sub-ureteric injection and 18(39.1%) unsuccessful RU’s were treated with re-injection in low risk group. Only 2(11.1%) re-injected RU’s had postoperative UTI and/or new renal scar at follow-up. In moderate risk group, 54 and 7 of 61 unsuccessful RU’s were treated with re-injection and ureteral re-implantation, respectively. 4(7.4%) of 54 had postoperative UTI and/or new renal scar at follow-up. In high-risk group, 13 and 12 of 25 unsuccessful RU’s treated with re-injection and ureteral re-implantation, respectively. Conclusion: We detected over treatment in low risk group. Success of the surgical correction was evident in moderate and high-risk group. The surgeon should be more pursuer in low risk and more invasive in moderate and high-risk group.

Highlights

Vesicoureteral reflux (VUR) is a very common urological anomaly that affects nearly 1% of children in the population (1)
The patients with VUR were classified as low, moderate and high-risk groups according to European Urology Association (EAU) paediatric urology guideline (1)
The demographic features of the patients at primary treatment were shown in table 1.The distribution of the patient’s outcome with primary treatment was shown in table 2. 33(%71.7) of 46RU’s were treated with sub-ureteric injection and 18(39.1%) unsuccessful renal units (RU)’s were treated with re-injection in low risk group

Summary

Introduction

Vesicoureteral reflux (VUR) is a very common urological anomaly that affects nearly 1% of children in the population (1). Management of VUR is one of the most controversial issues in paediatric urology. New renal scars can be occurred due to presence of febrile urinary tract infection (UTI), high-grade reflux, bilateral VUR, cortical abnormalities and lower urinary tract dysfunction (LUTD). The presence of renal scars, renal functions, clinical course, grade and laterality of reflux, associated anomalies, lower urinary tract functions, age, compliance, and parental preference are the key factors for determining best management of VUR (2). The optimal management of VUR is controversial and has been discussed over more than thirty years several times in the literature. The traditional approach of initial medical treatment after diagnosis and shifting to interventional treatment in case of breakthrough infections and new scar formation needs to be challenged

Methods

Results

Discussion

Conclusion