Introduction. Vesicoureteral reflux (VUR) is the most common pediatric urologic abnormality and since it can predispose to urinary tract infection and resultant kidney scar it is an important issue in pediatric nephrourology. Methods. A retrospective chart review and follow-up of 958 patients with primary VUR was performed in the Children’s Medical Center, Tehran, Iran. Children with primary vesicoureteral reflux were included in the study and these parameters were studied: age, sex, clinical presentation, VUR grade, sonographic findings, DMSA changes, treatment modality (medical, surgical or endoscopic) and response to treatment, hypertension (presence/absence), urinary tract infection recurrence and development of new kidney scars in patients under medical treatment. Results. VUR was more prevalent in girls. Sonography was unable to detect VUR in many cases. Presence of renal scars was strongly associated with degree of reflux. Medical management was effective in a substantial percentage of patients and they experienced full resolution of reflux. This was especially true for lower degrees of VUR. 17.6% of patients developed new kidney scars on followup which was associated with higher degrees of VUR. Hypertension and breakthrough urinary tract infection was an uncommon finding in our patients. Conclusion. Medical management, which means using prophylactic antibiotics for prevention of urinary tract infection, is effective in many cases of VUR especially in cases with lower degrees of VUR. Surgical and endoscopic procedures must be reserved for patients with higher degrees of VUR unresponsive to conservative management or in whom new scars may develop.
1. Fanos V, Cataldi L. Antibiotics or surgery for vesicoureteric reflux in children. Lancet 2004; 364: 1720-1722.
2. Wadie GM, Moriarty KP. The impact of vesicoureteral reflux treatment on the incidence of urinary tract infection. Pediatr Nephrol 2012; 27: 529-538.
3. Carpenter MA, Hoberman A, Mattoo TK, et al. The RIVUR trial: profile and baseline clinical associations of children with vesicoureteral reflux. Pediatrics 2013; 132: e34-e45.
4. Hoberman A, Greenfield SP, Mattoo TK, et al. RIVUR Trial Investigators. Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med 2014; 370: 2367.
5. Lopez PJ, Celis S, Reed F, Zubieta R. Vesicoureteral reflux: Current management in children. Current Urology Reports 2014; 15: 447.
6. Lebowitz RL, Olbing H, Parkkulainen KV, Smellie JM, Tamminen-Mobius TE. International system of radiographic grading of vesicoureteric reflux. International reflux study in children. Pediatr Radiol 1985; 15: 105-109.
7. Weiss R, Tamminen-Mobius T, Koskimies O, et al. characteristics at entry of children with severe primary vesicoureteral reflux recruitred for a multicenter, international therapeutic trial comparing medical and surgical management. The International reflux Study in Children. J Urol 1992; 148: 1644-1649.
8. Nickavar A, Hajizadeh N, Lahouti Haradashti A. Clinical course and effective factors of primary vesicoureteral reflux. Acta Med Iran 2015; 53(6): 376-379.
9. Goldraich NP, Goldraich IH. Follow up of conservatively treated children with high and low grade vesicoureteral reflux: A retrospective study. J Urol 1992; 148: 1688-1692.
10. Pendio Silva JM, Santos Diniz JS, Parizzoto Marino VS, et al. Clinical course of 735 children and adolescents with primary vesicoureteral reflux. Pediatr Nephrol 2006; 21: 981-988.
11. Smellie JM, Prescod NP, Shaw PJRidson RA, Bryant TN. Childhood reflux and urinary infection: A follow up of 10-14 years in 226 adults. Pediatr Nephrol 1998; 12: 727-736.
12. Abeysekara CK, Yasaratna BM, Abeyanunawardena AS. Long-term clinical follow up of children with primary vesicoureteric reflux. Indian Pediatr 2006; 43(2): 150-154.
13. Wang ZI, Xu H, Liu HM, et al. clinical analysis of 139 cases of primary vesicoureteric reflux in children. Zhonghua Er Ke Za Ahi 2008; 46(7): 518-521.
14. Elder Js. Imaging for vesicoureteral reflux-is there a better way? J Urol 2005; 174: 7-8.
15. Schwab CW Jr, Wu HY, Selman H, et al. Spontaneous resolution of vesicoureteral reflux: a 15 year prospective. J Urol 2002; 168: 2594-2599.
16. Smellie JM, Jodal U, Lax H, et al. Outcome at 10 years of severe vesicoureteric reflux managed medically: Report of the international reflux study in children. J Pediatr 2001; 139: 656-663.
17. Sjostrom S, Sillen U, Bachelard M, et al. Spontaneous resolution of high grade infantile vesicoureteral reflux. J Urol 2004; 172: 694-698.
18. Farnham SB, Adams MC, Brock JW 3rd, Pope JCT. Pediatric urological causes of hypertension. J Urol 2005; 173: 697-704.
19. Wallace DM, Rothwell DL, Williams DI. The long term follow up of surgically treated vesicoureteral reflux. Br J Urol 1978; 50: 479-484.
20. Smellie JM, Tamminen-Mobius T, Olbing H, et al. Fiveyear study of medical or surgical treatment in children with severe reflux: radiological renal findings. The International Reflux Study in Children. Pediatr Nephrol 1992; 6: 223-230.