Incidence Of Vesicoureteral Reflux Research Articles

Scintigraphic screening for renal damage in siblings of children with symptomatic primary vesico-ureteric reflux.

To define prospectively the incidence of renal parenchymal lesions in the siblings of patients treated at one institution for primary vesico-ureteric reflux (VUR). From January 1997 to October 1998, a prospective study including renal scintigraphy (using dimercaptosuccinic acid, DMSA) and a radionuclide cystogram was proposed systematically to the asymptomatic siblings of children treated for primary VUR. The radionuclide cystograms were interpreted as showing the presence or absence of VUR and the DMSA scan as symmetrical or asymmetrical differential function, with or with no renal defect. Fifty-five families gave informed consent, of whom 46 completed the study (eight refused secondarily and one was omitted by exclusion criteria), representing 46 symptomatic patients and 65 siblings. There were 17 siblings with VUR (26%) including two of 13 infants and 15 of 52 children aged > 18 months. One radionuclide cystogram failed. Of the 17 refluxing siblings, four had a history of symptomatic urinary tract infection; 62 of the 65 siblings had a DMSA scan, of which 56 were normal and six (10%) showed abnormalities (five asymmetrical differential function and one parenchymal defect). Only one of these six patients had VUR at the time of the evaluation and only one had a small kidney detected by ultrasonography on one side (and no VUR). There were no adverse effects associated with screening. This study confirms a significant overall incidence of VUR (26%) in the asymptomatic siblings of patients treated for primary VUR. From the results of the DMSA scan (only one sibling had a parenchymal defect), the systematic screening of asymptomatic siblings does not appear to be beneficial.

Color flow Doppler sonography: a reliable alternative to voiding cystourethrogram in the diagnosis of vesicoureteral reflux in children

Objectives. In children with urinary tract infection, the incidence of vesicoureteral reflux (VUR) is nearly 30% to 40%. The standard for the diagnosis of VUR is voiding cystourethrography (VCUG). This study assessed the role of color flow Doppler sonography (CFDS) in the diagnosis of VUR and ureteral jets. Methods. CFDS imaging was performed in 36 patients aged 6 months to 13 years during a 4-year period. All patients underwent CFDS and VCUG within 24 to 48 hours, but the findings of the VCUG were not reported to the sonologist. The ultrasound examinations were done using a color Doppler real-time machine. Representative images of the bladder events were recorded with a multiformat camera and on VHS videotape. Results. The duration of the Doppler signal varied from 0.4 to 7.5 seconds. In 31 (86.1%) of 36 patients, the results of CFDS correlated well with VCUG findings. There were three false-negative and two false-positive results in the present study. Six patients underwent reimplantation during the course of their treatment. CFDS was used as a follow-up modality at the end of 6 months, and the results correlated well with standard VCUG in 4 of these patients. In the remaining 2 patients, only CFDS was performed and correlation with VCUG was not possible. VCUG was considered the reference standard in assessing the sensitivity of CFDS. Conclusions. CFDS of the bladder during the filling and micturating phases is a reliable and sensitive modality for identifying VUR and demonstrating ureteral jets. CFDS nullifies the danger of exposure to ionizing radiation and avoids the unpleasant catheterization many of these children fear.

Vesicoureteral reflux in male and female neonates as detected by voiding ultrasonography

Vesicoureteral reflux (VUR) is assumed to be congenital, and its early diagnosis is desired in order to prevent acquired renal damage. However, the incidence of VUR in neonates remains to be revealed. Two thousand newborn babies (1048 boys and 952 girls) underwent voiding ultrasonography (an ultrasound examination of urinary tract during provoked voiding). Those who showed transient renal pelvic dilation during voiding, who had small kidneys, or who subsequently developed urinary infection underwent voiding cystourethrography. Transient renal pelvic dilation was observed in 16 babies (0.8%), including one boy with small kidneys. Among the rest of the babies, one boy had a small kidney, and nine babies subsequently developed urinary infection. Voiding cystourethrography revealed VUR in 24 ureters of 16 children (11 boys and 5 girls). Dimercaptosuccinate renoscintigraphy confirmed small kidneys, with generally reduced tracer uptake in a total of three boys, all having VUR. Voiding ultrasonography detected transient renal pelvic dilation in 17 (71%) of the 24 kidneys with VUR and, strikingly, 16 of the 17 (94%) kidneys with high-grade VUR (grade III or more). This study effectively detected VUR in 0.8% of the neonates (mostly of high grades and predominantly in males) and voiding ultrasonography showed a decided usefulness for the detection of VUR. The male preponderance of VUR in neonates was considered to be due to the occurrence of congenitally small kidneys, with reflux found exclusively in males and easier ultrasound detection of VUR in male neonates because the majority of diagnoses are reported to be high grades of VUR.

Paediatric ureteroscopy for ureteric calculi: a 4-year experience.

To study the efficacy and safety of ureteroscopy in the management of paediatric ureteric calculi at various levels. The records of 50 ureteroscopic procedures performed on 43 children (age range 6 months-12 years) for primary ureteric calculi or ureteric fragments after electrohydraulic shockwave lithotripsy (EHWL) were analysed retrospectively. The distribution of the calculi was in nine in the upper upper, seven in the mid and 30 in the lower ureter, with a mean stone burden of 1.26 cm. Ureteroscopy was performed with the 8.5/9.5/11.5 F Wolf ureteroscopes, and EHL was used as the primary method of fragmentation. Intravenous urograms were available in 34 children (79%) and micturating cystography (MCUG) was performed in 23 children (54%) during the follow-up. An overall stone-free status was achieved in 40 children (93%) after performing 47 ureteroscopies (94%). Stones were completely cleared in 78%, 100% and 97% of the procedures in the upper, mid and lower ureters, respectively. In three children the procedure failed and they were salvaged by uretero-lithotomy. During the procedures, an upper ureteric perforation occurred in one patient and a lower perforation in another. MCUG revealed low grade vesico-ureteric reflux in 17% of the patients, but close follow-up showed the reflux to be sterile and clinically insignificant. Ureteroscopy was safe and effective for the management of mid and lower ureteric calculi but the results for upper ureteric calculi were marginally inferior. Ureteroscopy must be performed judiciously to minimize ureteric injury in children. The incidence of vesico-ureteric reflux after mechanical dilatation of the intramural ureter was infrequent and clinically insignificant.

Vesico-ureteric reflux in adult patients with spinal injury.

To review the incidence, aetiology, treatment and prognosis of vesico-ureteric reflux (VUR) in patients in a regional spinal injuries centre. A retrospective review of radiological investigations revealed 34 of 447 (8%) patients with VUR on at least one study. The notes of these patients were examined to determine their management and outcome. Most patients developed VUR within 4 years of injury; the underlying intravesical pressure was high in half the patients studied. Patients were managed aggressively with a variety of medical and surgical techniques. The VUR of 15 patients resolved completely and in three patients there was some improvement. Renal function deteriorated in three patients as assessed by isotopic scanning. Two patients were transferred to our unit in end-stage renal failure associated with VUR and died within one year. VUR continues to be a problem in patients with spinal injury and remains potentially fatal through the effects of high transmitted pressure and infection. Renal failure does not always develop as a consequence of the combination of VUR and high intravesical pressure. No single aetiological factor for VUR was found. With active early treatment, the incidence of VUR can be minimized and long-term complications avoided.

Detection of low-grade vesicoureteral reflux in children by color Doppler imaging mode.

Vesicoureteral reflux (VUR) is common in children with urinary tract infections (UTI) and may result in renal scarring or reflux nephropathy. To date, the primary diagnostic tool has been voiding cystourethrography (VCUG). A new technique for evaluation of grade 1 and 2 VUR is described using color Doppler imaging-mode cystography (CDIMC): 77 children, aged 7 months to 14 years, were examined for VUR by CDIMC and standard VCUG. According to the established reflux sonography (US) using a real-time mode, all patients selected for this study had a normal urinary tract on conventional gray-scale US. We studied 154 ureters, and a total of 31 were found to be refluxing on CDIMC and 30 on VCUG. A positive sonogram was defined as visualization of Doppler signals from the bladder to the ureter during the course of bladder filling. Taking VCUG as the gold standard, we had ten false-positive findings. The false-positive rate of 18.5% may have been due to the shorter observation time of fluoroscopy. Comparison of the two methods shows CDIMC to be 70% sensitive with a specificity of 92% in the detection of VUR grade 1 and 2. To evaluate the incidence of asymptomatic low-grade VUR in a non-infected population, a second series of 38 children (19 males, 19 females) aged 3 to 15 years (mean 8.8 years) with normal urologic status and urine cultures were studied by color Doppler imaging mode (CDIM) for detection of asymptomatic low-grade VUR. Four children were found to have a unilateral refluxing ureter. The incidence of VUR in children with a normal urinary tract and no prior UTI was 10.5%. In conclusion, CDIMC can be used as a possible alternative to standard VCUG for the screening and follow-up of low-grade VUR. In addition, our study indicates that asymptomatic grade 1 and 2 reflux might be a physiological condition.

Incidence of vesicoureteral reflux in children with unilateral renal agenesis: J.T. Song, M.L. Ritchey, J.M. Zerin, et al. J Urol 153:1249–1251, (April), 1995

Incidence of vesicoureteral reflux in children with unilateral renal agenesis: J.T. Song, M.L. Ritchey, J.M. Zerin, et al. J Urol 153:1249–1251, (April), 1995

Familial Vesicoureteral Reflux

To the Editor.— I read with interest a recent article in Pediatrics concerning screening for familial vesicoureteral reflux (VUR).1 The authors found a 46% incidence of VUR in the siblings of index cases. These index cases had VUR diagnosed by voiding cystourethrograms (VCUGs) which were performed because the patients had experienced a urinary tract infection (UTI). This was an interesting and well-done study. It suffers, however, from the same problem as other studies on this subject,2,3 ie, the lack of a control population to define the underlying incidence of VUR in "normal" individuals from "normal" families.

Familial Vesicoureteral Reflux

In Reply.— We are happy to address Dr Roscelli's concerns regarding our paper on familial reflux screening; we are not in complete agreement with him, however. First of all, the incidence of vesicoureteral reflux in the healthy human being is accepted as being 0.4% to 1.8%.1 The only study to show a significantly higher rate was the Kollerman study referred to by Dr Roscelli. This study has been roundly criticized because it was performed with high pressure injection, and it is the only such study to show a high rate of reflux in healthy children.

Detecting vesico-ureteral reflux in asymptomatic siblings of children with reflux by direct radionuclide cystography

The incidence of vesicoureteral reflux (VUR) among asymptomatic siblings of children with VUR is much higher than the estimated incidence in the general population. It might be expected that identifying them and keeping them under close observation and/or either surgical or conservative treatment, might reduce the risk of renal scarring. Fifty-three asymptomatic children, all under 6 years of age and all siblings of children with proven VUR, were studied and direct radionuclide voiding cystography (DRVC). There were 31 (58%) boys, and 22 (42%) girls. Nine children (17%) were younger than 1 year, 13 (25%) were between 1 and 2 years of age, while 31 (58%) were older than 2 years. VUR was detected in 22 (42%) of the 53 siblings. The incidence of VUR varied considerably according to the age, and sex of the child, the highest being in boys younger than 1 year. Most of the severe reflux was seen in children under 2 years of age. Out of 11 patients with VUR, grade 2 and 3, there were 10 younger than 2 years, whereas, only 2 of the 11 siblings with VUR, grade 1 were younger than 2 years of age. The mean age of children with VUR grades 2 and 3 was 19 months, compared to the mean age of 50 months for those with VUR grade 1. DRVC, a highly sensitive method, exposes the patient to much less radiation than X-ray voiding cystography. We believe that the benefit of detecting VUR in asymptomatic siblings with DRVC outweights the invasiveness of the procedure. The predictive value of positive family history alone in identifying VUR in our study was 42%.(ABSTRACT TRUNCATED AT 250 WORDS)

Pyelonephritis Following Pediatric Renal Transplant: Increased Incidence With Vesicoureteral Reflux

The association between pyelonephritis and vesicoureteral reflux (VUR) following pediatric renal transplantation is unclear. To understand the relationship of vesicoureteral reflux with urinary tract infection (UTI) and pyelonephritis, 67 patients were evaluated for reflux and pyelonephritis. Sixty-seven pediatric patients, aged 2 to 18 (39 males and 28 females) underwent renal transplantation. Beginning in 1982, all patients underwent voiding cystourethrography or radionuclide voiding studies 1 to 3 months postoperatively to assess the incidence of VUR. Techniques of ureteroneocystostomy (UNC) included the Leadbetter-Politano (L-p) in 39 cases, and two different modifications of the LICH (herein called LICH-1 and LICH-2) in 30 cases. Urinary cultures were performed routinely. Pyelonephritis was considered present in any patient with UTI and increased serum creatinine or fever>38.5. VUR occurred in 36% of patients; highest in LICH-1 (79%), intermediate in L-P (22%), and lowest in LICH-2 (9%). VUR was not statistically significantly higher in females (43%) v males (31%). UTI occurred in 37% of patients. The difference in incidence between females (54%) and males (26%) was significant ( P v 33% in patients without reflux (NS). However, pyelonephritis that occurred in 16% of cases overall was present in 82% of UTIs in patients with reflux v 14% of UTls in patient without reflux ( P

Urinary Infection and Malformations of Urinary Tract in Infancy

One hundred and forty infants with their first urinary tract infections were studied and pronounced differences in age and sex were found. Two thirds of the patients had their first urinary tract infection during the first three months of life, and boys were significantly younger. There was a predominance of boys from 1-3 months old, but of girls thereafter. Obstructive uropathies occurred more often in boys, and during the first two months of life. The incidence of vesicoureteric reflux was similar for both sexes. Malformations recognised after urinary tract infections were compared with urinary tract malformations recognised prenatally. Fetal urinary tracts were evaluated in just over half of all pregnancies during the study period. Obstructive uropathies and multicystic dysplastic kidneys were more often diagnosed prenatally, and most refluxes were diagnosed after the urinary tract infection. In conclusion age and sex differences are common in urinary tract infection, and even though many urinary tract malformations were diagnosed prenatally this did not influence the high incidence of malformations recognised after urinary tract infection in infancy.

Urinary infection and malformations of urinary tract in infancy.

One hundred and forty infants with their first urinary tract infections were studied and pronounced differences in age and sex were found. Two thirds of the patients had their first urinary tract infection during the first three months of life, and boys were significantly younger. There was a predominance of boys from 1-3 months old, but of girls thereafter. Obstructive uropathies occurred more often in boys, and during the first two months of life. The incidence of vesicoureteric reflux was similar for both sexes. Malformations recognised after urinary tract infections were compared with urinary tract malformations recognised prenatally. Fetal urinary tracts were evaluated in just over half of all pregnancies during the study period. Obstructive uropathies and multicystic dysplastic kidneys were more often diagnosed prenatally, and most refluxes were diagnosed after the urinary tract infection. In conclusion age and sex differences are common in urinary tract infection, and even though many urinary tract malformations were diagnosed prenatally this did not influence the high incidence of malformations recognised after urinary tract infection in infancy.

Aspects of Brazilian paediatric nephrology.

Brazil is a large country with different population densities in its five geographical regions, each of which has severe but unevenly distributed socioeconomic problems which affect the health care system. This makes the accurate assessment of renal disease in the large paediatric population which comprises 40% of the total population especially difficult. This paper analyses the experience of one paediatric nephrology unit. Urinary tract infection affecting 44% of the patients was the most common disease. There was a high incidence of vesicoureteric reflux and renal scarring. The proportion of poststreptococcal glomerulonephritis did not exceed 11%, whilst nephrotic syndrome in its various forms represented 20% of the patients. End-stage renal failure was common and difficult to manage. Renal transplantation could not meet the demand for a variety of reasons, thus there has been an alarming annual increase in the number of patients on dialysis. Other diseases encountered in smaller numbers included acute renal failure, other glomerulopathies (mainly IgA), tubulopathies and renal lithiasis.

Pregnancy outcome in women with reflux nephropathy--a review of experience at the Royal Women's Hospital Brisbane, 1977-1986.

The outcome of pregnancy was examined, retrospectively, in women with a diagnosis of reflux nephropathy attending The Royal Women's Hospital from January, 1977 to August, 1986. Of 15 women, 10 were known to have had the disease antepartum and 5 were diagnosed postpartum. On the basis of plasma creatine concentration prior to pregnancy, 10 patients had 22 pregnancies with normal renal function and 5 patients had 7 pregnancies with plasma creatinine concentrations ranging from 0.12 to 0.17 mmol/l. The pregnancies of the women with normal renal function were complicated by urinary tract infections, while those with impaired renal function were associated with preeclampsia. The perinatal mortality for both groups were zero. A relatively low incidence of vesicoureteric reflux was found in 12 of the offspring who were subjected to micturating cystourethrography (mild reflux in 1 of 24 ureters).

Vesicoureteral Reflux in Asymptomatic Siblings of Patients With Known Reflux: Radionuclide Cystography

The familial nature of vesicoureteral reflux among siblings of patients with vesicoureteral reflux has been reported to be from 8% to 32%. These included both symptomatic and asymptomatic siblings. The incidence of vesicoureteral reflux in asymptomatic siblings, however, has not been studied extensively. Sixty asymptomatic siblings of patients known to have vesicoureteral reflux were studied with radionuclide voiding cystography. Their ages ranged from 2 months to 15 years (mean, 4.2 years). Vesicoureteral reflux was detected in 27 of 60 (45%) of the siblings. Vesicoureteral reflux was unilateral in 15 and bilateral in 12 of the siblings. Radionuclide cystography is more sensitive than radiographic cystography and results in a very low radiation dose to the patient. The gonadal dose with radionuclide cystography is only 1.0 to 2.0 mrads. Because of these features, radionuclide cystography is a nearly ideal technique for the diagnosis of vesicoureteral reflux in siblings of patients with known vesicoureteral reflux. All siblings (symptomatic or asymptomatic) of patients with known vesicoureteral reflux should have a screening radionuclide cystography.

Vesicoureteric reflux following renal transplantation: a simple method of ureteric implantation.

We have used a simple method of ureteroneocystostomy in renal transplant patients. This entails a no-tunnel "drop-in" with a long free segment protruding into the bladder lumen. The incidence of vesicoureteric reflux was investigated in 81 transplant patients who had a follow-up period ranging from 4 months to 15 years (mean 3.7 years); 29 of these patients had recurrent urinary tract infections. Micturating cystography demonstrated reflux in 6 patients (7.4%). In these 6 patients the presence of reflux had no deleterious effect on renal function and the infections were easily controlled with long-term antibiotics. In the 52 patients without injury infection no reflux was demonstrated. The conclusions based on this study indicate that (1) in the absence of recurrent infection there are no indications for micturating cystography and (2) this method of ureteroneocystostomy is expedient and has a low incidence of reflux.

Study of bilharzial uropathy by means of hippuran I131 extended renography.

Renal, ureteral, and vesicle functions were evaluated in 209 patients with obstructive lesions of the ureter due to schistosomiasis haematobia (bilharziasis), using Hippuran I131 extended renography. High values for Tmax. and T 1/2 were noted for both kidneys irrespective of radiological diagnosis of a left- or right-sided lesion. A high percentage of residual vesicle urine was demonstrated in a number of patients with bilharzial uro-obstructive lesions. The incidence of vesicoureteral reflux in relation to different lesions was also correlated. The results of this study support the concept that urinary schistosomiasis is a progressive disease which affects mainly the urinary bladder and lower ureter. The data obtained demonstrate the efficacy of extended renography in assessing renal, ureteral, and vesical function in patients with bilharziasis.

Ureteral function in pregnant women: V. Incidence of vesicoureteral reflux and its effect upon ureteral contractility

the incidence of vesicoureteral reflux during normal pregnancy has not been definitely stated; therefore, a comparison was made between normal nonpregnant and pregnant women by vesical filling with a colored solution, spontaneous voiding, and cystoscopy, to look for colored ejection, this being considered as reflex. Reflux was not found in nonpregnant women or in women in the first and second trimesters of pregnancy, while it increased up to 4.3 per cent in gravidas of the third trimester. By recording intraureteral pressure, we found that there was no difference between bladder pressure and ureteral contractility in pregnant patients with and without reflux. On the other hand, basal ureteral pressure was higher in women with reflux. This increase suggests that the etiology of reflux may be obstructive. However, the higher pressure could be due to reflux in itself which would counterbalance ureteral pressure.

The incidence of vesicoureteral reflux in the premature child: P. C. Peters, D. E. Johnson and J. H. Jackson, Jr. J. Urol. 97:259–260 (Feb.), 1967

The incidence of vesicoureteral reflux in the premature child: P. C. Peters, D. E. Johnson and J. H. Jackson, Jr. J. Urol. 97:259–260 (Feb.), 1967