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Persistence and recurrence of vesicoureteric reflux in children after endoscopic therapy – implications of a risk-adapted follow-up

Haid, Bernhard, Berger, Christoph, Roesch, Judith, Becker, Tanja, Koen, Mark, Langsteger, Werner und Oswald, Josef (2015) Persistence and recurrence of vesicoureteric reflux in children after endoscopic therapy – implications of a risk-adapted follow-up. Central European journal of urology, 68 (3). pp. 389-395. ISSN 2080-4806

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Kurzfassung

INTRODUCTION There is no well-defined follow-up scheme available to reliably detect persistent or recurrent vesicoureteric reflux (VUR) after endoscopic therapy (ET), but also to reduce postoperative invasive diagnostics in these children. Our aim was the evaluation of possible predictors of persistence and recurrence of VUR, in order to elaborate and test a risk-adapted follow-up regimen. MATERIAL AND METHODS 92 patients (85/92%f, 7/8%m, age 2.99y) underwent direct isotope cystography (DIC) three months after ET. Persistent or recurrent VUR, scarring on dimercaptosuccinic acid (DMSA) scans and further fUTIs after therapy (follow-up 24.6 m) were documented and analysed. RESULTS VUR persistence 3 months after ET was found in 11 (11.9%) patients; recurrent VUR in 4 (4.3%) patients. Scarring on preoperative DMSA and dilating VUR (°III and °IV) were significantly associated with recurrent VUR. If only children with preoperative positive DMSA scan or dilating VUR would have undergone DIC, only 58/92 DICs (64%) would have been necessary. Only 45.5% of otherwise detected VURs would have been identified using this risk-adapted strategy. CONCLUSIONS Limiting invasive follow-up diagnostics (VCUG) and, therewith, the radiation burden in a predefined group of patients at risk for persistence or recurrence of VUR is not recommended, due to the significant chance of missing persistent or new onset contralateral VUR. Therefore, we recommend a routine follow-up VCUG after ET. Further prospective scientific efforts to evaluate new, alternative factors influencing persistence and recurrence of VUR, in order to establish an effective follow-up strategy, are warranted.

Typ des Eintrags: Fachpublikation (peer reviewed)
Bereiche: Ordensklinikum Linz Barmherzige Schwestern > Nuklearmedizin
Benutzer: Prof. Werner Langsteger
Hinterlegungsdatum: 19 Mär 2019 11:50
Letzte Änderung: 19 Mär 2019 11:50
URI: http://eprints.vinzenzgruppe.at/id/eprint/8542

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