| Follow-Up Study of Urinary Tract Infection Associated with Vesicoureteral Reflux |
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Do Whan Kil, Jea Eun Lee, Wan Seob Kim |
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Department of Pediatrics, Presbyterian Medical Center, Chonju, Korea |
| 방광요관역류를 동반한 요로감염증 환아의 추적 관찰 |
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길도환, 이재은, 김완섭 |
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전주예수병원 소아과 |
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| Abstract |
Purpose
: Vesicoureteral reflux(VUR) is the major cause of urinary tract infection (UTI)
in children. Prolonged untreated UTI associated with VUR may result in serious complications,
such as renal scarring, renal atropy, and decreased renal function. Therefore, follow up must
be continued until UTI is cured completely, to prevent of serious complication. The authors
conducted this study to evaluate results of the follow-up of UTI associated with VUR.
Methods
: During the period from March 1991 to July 1996, we had 47 children with
urinary tract infection associated with vesicoureteral reflux who were admitted to the
Department of Pediatrics and Urology, Presbyterian Medical Center. The patients were
managed medically or surgically.
Results
:
1) There were no differences in sex distribution in the 47 cases with VUR. The
intensity of 67 refluxing ureters, classified by the International Reflux Study Committee,
grade Ⅰ, 10 cases; grade Ⅱ, 11 cases; grade Ⅲ, 20 cases; grade Ⅳ, 17 cases; grade Ⅴ,
9 cases.
2) The most common causative agent in UTI was E. coli. Fourty-six cases underwent
ultrasonography and 24 showed abnormal findings. Fourty-four cases underwent a
99mTc-DMSA renal scan, and 25 showed abnormal findings. The incidence of renal
scarring showed a direct correlation with the severity of VUR.
3) The incidence of urinary tract infection during follow-up did not differ between the
groups medical management versus surgical management.
4) Fourty-four refluxing ureters were treated primary medically and 38 of them were
followed up. Twenty-five of the 38 ureters were disappeared or improved, and 9 persisted.
The rest showed aggravation of reflux. Twenty-five of the 32 refluxing ureters showed
disappearance or improvement of reflux before 5 years of age, The spontaneous cure rate
of vesicoureral reflux seemed to be higher in the cases with a milder grade of reflux.
5) Although refluxing ureter disappeared completely on VCUG, we found that followup
is continued until the disappearance of reflux is confirmed on two serial VCUG.
6) Thirty-three refluxing ureters were treated surgically and one of them was
stationary on follow-up VCUG, while the others were cleared.
Conclusions
: As a result of follow-up the 47 patients with VUR, the incidence of
urinary tract infection did not differ between the groups medical versus surgical management.
Rates of disappearance of VUR in medical and surgical management were 66%,
97%, respectively. The spontaneous cure rate of VUR seemed to be higher in the cases
with a milder grade of reflux and before 5 years of age. We found that follow-up is
continued until the disappearance of reflux is confirmed on two serial VCUG. |
| Key Words:
Urinary tract infection, Vesicoureteral reflux |
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