Dysfunctional elimination syndrome is a negative predictor for vesicoureteral reflux.
ABSTRACT We investigated the likelihood of finding vesicoureteral reflux (VUR) in patients with urinary tract infections (UTIs), accompanied by fever or dysfunctional elimination syndrome (DES).
Two hundred consecutive voiding cystourethrograms performed in 1997-2002 for a diagnosis of UTI were reviewed. Fever, DES, and the grade and laterality of VUR were recorded. Patients were stratified into two groups by age to allow for assessment of DES symptoms in the older patient population: <2 years (n=68) and > or =2 years (n=132). Ratios were compared using a two-tailed Fisher's exact test.
Of the children> or =2 years old, 64/132 (48%) had VUR. Patients who were non-febrile with DES were less likely than patients who were febrile without DES to have VUR [12/34 (35%) vs 23/34 (68%), P=0.02], whereas the risk of dilating VUR [5/34 (15%) vs 11/34 (32%), P=0.15] and bilateral VUR [4/34 (12%) vs 11/34 (32%), P=0.08] was not statistically different. In febrile patients, the presence of DES was associated with a lower risk of VUR [22/51 (43%) vs 23/34 (68%), P=0.03] and dilating VUR [5/51 (10%) vs 11/34 (32%), P=0.01], but not bilateral VUR [8/51 (16%) vs 11/34 (32%), P=0.11].
Children with non-febrile UTI and DES have a significantly lower risk of having VUR compared to children with febrile UTI and no DES. Among children with a history of UTI, DES is a negative predictor for VUR.
- The Journal of urology 03/2010; 183(3):856-7. DOI:10.1016/j.juro.2009.12.062 · 3.75 Impact Factor
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ABSTRACT: Primary vesicoureteral reflux (VUR) is a common congenital urinary tract abnormality in children. There is considerable controversy regarding its management. Preservation of kidney function is the main goal of treatment, which necessitates identification of patients requiring early intervention. To present a management approach for VUR based on early risk assessment. A literature search was performed and the data reviewed. From selected papers, data were extracted and analyzed with a focus on risk stratification. The authors recognize that there are limited high-level data on which to base unequivocal recommendations, necessitating a revisiting of this topic in the years to come. There is no consensus on the optimal management of VUR or on its diagnostic procedures, treatment options, or most effective timing of treatment. By defining risk factors (family history, gender, laterality, age at presentation, presenting symptoms, VUR grade, duplication, and other voiding dysfunctions), early stratification should allow identification of patients at high potential risk of renal scarring and urinary tract infections (UTIs). Imaging is the basis for diagnosis and further management. Standard imaging tests comprise renal and bladder ultrasonography, voiding cystourethrography, and nuclear renal scanning. There is a well-documented link with lower urinary tract dysfunction (LUTD); patients with LUTD and febrile UTI are likely to present with VUR. Diagnosis can be confirmed through a video urodynamic study combined with a urodynamic investigation. Early screening of the siblings and offspring of reflux patients seems indicated. Conservative therapy includes watchful waiting, intermittent or continuous antibiotic prophylaxis, and bladder rehabilitation in patients with LUTD. The goal of the conservative approach is prevention of febrile UTI, since VUR will not damage the kidney when it is free of infection. Interventional therapies include injection of bulking agents and ureteral reimplantation. Reimplantation can be performed using a number of different surgical approaches, with a recent focus on minimally invasive techniques. While it is important to avoid overtreatment, finding a balance between cases with clinically insignificant VUR and cases that require immediate intervention should be the guiding principle in the management of children presenting with VUR.European Urology 06/2012; 62(3):534-42. DOI:10.1016/j.eururo.2012.05.059 · 12.48 Impact Factor
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ABSTRACT: diyopatik detrüsör aşırı aktivitesi ile vezikoüreteral reflü derecesi arasındaki ilişkiyi değerlendirmeyi amaçlayan çalışmayı ilgi ile okuduk . Vezikoüreteral reflü (VUR) ve alt üriner sistem disfonksiyonu (AÜSD) arasındaki ilişki Avrupa Üroloji Birliği kılavuzunda da belirtildiği gibi hem tanı hem de tedavi yönetimi açısından birbiri ile sıkı ilişki içinde olmasına rağmen aralarındaki bağı destekleyen kuvvetli çalışmalar yoktur . Çalışmaların çoğu tanımlayıcı, kontrol grubu olmayan ve retrospektif olup kanıt düzeyi düşüktür. Son zamanlardaki güncel çalışmalardan İsveç reflü grubunun verilerine göre VUR ve AÜSD beraberliği olan çocuklarda tedavi sonucu diğerlerine göre özellikle böbrek hasarı açısından daha kötü olduğu saptanmıştır  . AÜSD olan çocuklarda VUR sıklıkla düşük dereceli olup, ultrasonografi bulguları normaldir. Bu nedenle AÜSD olan tüm çocuklarda voiding sistoüretrografi yapma endikasyonu bulunmamaktadır. AÜSD olan çocuklarda ateşli idrar yolu enfeksiyonu öyküsü mev-cutsa VUR saptanma olasılığı yüksek olacağı için video ürodinami çalışması yapılmalıdır. AÜSD tedavisi başarısız olan çocuk-larda ürodinamik değerlendirme yapılmalıdır. Özellikle güncel literatürde yazarlarında belirttiği gibi detrüsör aşırı aktivitesi ve VUR arasında ilişkiyi gösteren kesin çalışmalar olmamakla birlikte ürodinamik inceleme ve voidingsistoüretrografi yapılması üzerinde durulmaktadır  . Kaynaklar 1. Kılınç F, Is the Grade of Vesicoureteral Reflux Related with Detrusor Overactivity? J Clin Anal Med 2014;5(4):273-5. 2. Tekgül S, Riedmiller H, Hoebeke P, Kočvara R, Nijman RJ, Radmayr C, et al. EAU Guidelines on Vesicoureteral Reflux in Children. Eur Urol 2012;62:534–542. 3. Sillén U, Brandström P, Jodal U, Holmdahl G, Sandin A, Sjöberg I, et al. The Swedish reflux trial in children: v. Bladder dysfunction. J Urol 2010;184:298–304. 4. Colen J, Docimo SG, Stanitski K, Sweeney DD, Wise B, Brandt P, et al. Dysfunctional elimination syndrome is a negative predictor for vesicoureteral reflux. J Pediatr Urol 2006;2:312–5.