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vesicoureteral reflux

Backflow of urine from the bladder into the ureter, unilaterally or bilaterally, during rest or especially during urination. Etiology: 1) congenital 2) secondary to obstruction of the urinary outflow tract 3) any disease involving the urinary ureteral orifices Special laboratory: - voiding cystourethrogram Complications: 1) recurrent urinary tract infections [7] 2) hydronephrosis 3) renal scarring 4) chronic renal insufficiency Management: 1) antibacterial prophylaxis a) daily Bactrim associated with fewer recurrences of urinary tract infection (UTI) in young children (26% vs. 37%) [6] - 3 mg of trimethoprim + 15 mg of sulfamethoxazole per kg body weight - number needed to treat: 8 children for 2 years to prevent 1 UTI [6] b) does not prevent renal scarring [6] c) of no benefit [4,5] d) reduces risk of recurrent urinary tract infection but increases risk of multidrug resistant UTI [8] 2) bowel & bladder hygiene

Related

voiding cystourethrogram (VCUG)

Specific

reflux nephropathy

General

urologic disease reflux sign/symptom

References

  1. Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  3. Journal Watch 22(2):15, 2002 Smellie JM, Jodal U, Lax H, Mobius TT, Hirche H, Olbing H; Writing Committee, International Reflux Study in Children (European Branch). Outcome at 10 years of severe vesicoureteric reflux managed medically: Report of the International Reflux Study in Children. J Pediatr. 2001 Nov;139(5):656-63. PMID: 11713442
  4. Garin EH, Olavarria F, Garcia Nieto V, Valenciano B, Campos A, Young L. Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study. Pediatrics. 2006 Mar;117(3):626-32. PMID: 16510640 - Wald ER. Vesicoureteral reflux: the role of antibiotic prophylaxis. Pediatrics. 2006 Mar;117(3):919-22. No abstract available. PMID: 16510674
  5. Pennesi M et al. Is antibiotic prophylaxis in children with vesicoureteral reflux effective in preventing pyelonephritis and renal scars? A randomized, controlled trial. Pediatrics 2008 Jun; 121:e1489 http://dx.doi.org/10.1542/peds.2007-2652 PMID: 18490378
  6. The RIVUR Trial Investigators Antimicrobial Prophylaxis for Children with Vesicoureteral Reflux. N Engl J Med. May 4, 2014 PMID: 24795142 http://www.nejm.org/doi/full/10.1056/NEJMoa1401811 - Ingelfinger JR and Stapleton FB Antibiotic Prophylaxis for Vesicoureteral Reflux - Answers, Yet Questions. N Engl J Med. May 4, 2014 PMID: 24795143 http://www.nejm.org/doi/full/10.1056/NEJMe1404774
  7. Tullus K. Vesicoureteric reflux in children. Lancet 2015 Jan 24; 385:371 PMID: 25164069 - Tullus K. Vesicoureteric reflux in children. Lancet 2015 Jan 24; 385:371 PMID: 25164069
  8. Selekman RE, Shapiro DJ, Boscardin J et al. Uropathogen resistance and antibiotic prophylaxis: A meta- analysis. Pediatrics 2018 Jul; 142:e20180119 PMID: 29954832 http://pediatrics.aappublications.org/content/142/1/e20180119