Evolving surgical management of pediatric vesicoureteral reflux: is open ureteral reimplantation still the 'Gold Standard'?

• Type of Material: Article
• Authors: Andrew Kirsch, Emory University; Angela M. Arlen, Yale University
• Language: English
• Date: 2020-05-01
• Publisher: Sociedade Brasileira de Urologia
• Publication Version: Final Published Version
• Copyright Statement: © SciELO - Scientific Electronic Library Online.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1590/S1677-5538.IBJU.2020.99.05
• Title of Journal or Parent Work: International Braz J Urol
• Volume: 46
• Issue: 3
• Start Page: 314
• End Page: 321
• Grant/Funding Information: None declared
• Keywords: Children; Vesico-Ureteral Reflux; Science & Technology; Surgery; Life Sciences & Biomedicine; Injection; Urinary tract infections; Diagnosis; Outcomes; Urology & Nephrology; Endoscopic treatment; Pediatrics; Copolymer; Dextranomer/hyaluronic acid; Ureteral Diseases; Term follow-up
• Research Categories: Health Sciences, Rehabilitation and Therapy; Health Sciences, Medicine and Surgery; Health Sciences, Pathology

Abstract

Vesicoureteral reflux, the retrograde flow of urine from the bladder into the upper urinary tract, is one of the most common urologic diagnoses in the pediatric population. Once detected, therapeutic options for urinary reflux are diverse, ranging from observation with or without continuous low-dose prophylactic antibiotics to a variety of operative interventions. While a standardized algorithm is lacking, it is generally accepted that management be tailored to individual patients based on various factors including age, likelihood of spontaneous resolution, risk of subsequent urinary tract infections with renal parenchymal injury, and parental preference. Anti-reflux surgery may be necessary in children with persistent reflux, renal scarring or recurrent pyelonephritis after optimization of bladder and bowel habits. Open, laparoscopic/robotassisted and endoscopic approaches are all successful in correcting reflux and have been shown to reduce the incidence of febrile urinary tract infections.