Abstract
PURPOSE It is widely recommended that medical management be used for infants younger than one year with vesicoureteral reflux (VUR). However some infants suffer recurrent urinary tract infection (UTI) in spite of continuous prophylactic antibiotics treatment which result in them undergoing anti-reflux surgery. We investigated the risk factors of recurrent UTI in infants with VUR. MATERIAL AND METHODS The comparative study was performed between infantile VUR with recurrent UTI (Group I, 20 males, mean age 2.7 months) and without UTI (Group II, 20 males and 4 females, mean age 4.7 months). We analysed sex, the time of UTI episode, degree and bilaterality of the reflux, hydronephrosis, renal scars, associated congenital anomalies, voiding dysfunction and delayed ureteral excretion of refluxed contrast on VCUG. RESULTS In univariable Cox survival-time regression, the younger mean age at first UTI, bilateral and grade 4 to 5 VUR and hydronephrosis on initial ultrasonography significantly increased the risk of recurrent UTI (p<0.05). In multivariable analysis, high grade and bilateral VUR were associated with increased risk of recurrent UTI. Among them, the most significant factor was the grade of VUR (p=0.009). In the group with recurrent UTI, 80 % of the patients presenting high grade VUR showed delayed contrast passage on VCUG, but the group with non-recurrent UTI did not. Urodynamic studies were performed on 11 infants with recurrent UTI and 2 showed decreased bladder capacity and 1 showed a large residual urine volume. CONCLUSIONS In the first year of life, high grade and bilateral VUR significantly increased the risk of recurrent UTIs. The delayed contrast passage on VCUG was the most significant factor associated with increased risk of recurrent UTIs.
Published Version
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