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Evolution and Prognosis Value of Intrarenal Reflux
S74 analysed sex, the time of UTI episode, degree and bilaterality of the reflux, hydronephrosis, renal scars, associated congenital anomalies, voiding dysfunction and delayed ureteral excretion of refluxed contrast on VCUG.
RESULTS In univariable Cox survival-time regression, the younger mean age at first UTI, bilateral and grade 4 to 5 VUR and hydronephrosis on
ESPU Programme 2008 initial ultrasonography significantly increased the risk of recurrent UTI (p<0.05). In multivariable analysis, high grade and bilateral VUR were associated with increased risk of recurrent UTI. Among them, the most significant factor was the grade of VUR (p¼0.009). In the group with recurrent UTI, 80 % of the patients presenting high grade VUR showed delayed contrast passage on VCUG, but the group with non-recurrent UTI did not. Urodynamic studies were performed on 11 infants with recurrent UTI and 2
showed decreased bladder capacity and 1 showed a large residual urine volume.
CONCLUSIONS In the first year of life, high grade and bilateral VUR significantly increased the risk of recurrent UTIs. The delayed contrast passage on VCUG was the most significant factor associated with increased risk of recurrent UTIs.
From 12:23 to 12:28 # S16-3 (O) EVOLUTION AND PROGNOSIS VALUE OF INTRARENAL REFLUX Georges AUDRY, Julia BOUBNOVA, Aline SERGENT-ALAOUI*, Georges DESCHENES, WITH SECTION FRANCAISE D’UROLOGIE PEDIATRIQUEy Hopital TROUSSEAU, Pediatric Surgery, Paris, FRANCE - *Hopital TROUSSEAU, Nuclear Medecine, Paris, FRANCE - yHopital Robert Debre, Pediatric Nephrology, Paris, FRANCE
PURPOSE The aim of this multicenter, prospective observational case-control study was to evaluate the prognostic significance of intrarenal reflux (IRR).
who got recurrent urinary tract infections (UTI). DMSA scan performed at study entry, by 18 and 36 months of follow-up was scored for each refluxing renal unit from 0 (normal) to 3 (severe).
RESULTS
(1.070.18; NS). During the follow-up, the incidence of UTI and new renal scars were similar between the two groups. In addition, 18/33 patients with IRR and 13/27 patients in the control group underwent anti-reflux surgery due to recurrent UTI (Chi-square NS).
MATERIAL AND METHODS Thirty three patients aged 0 to 3 years with IRR, followed during three years, were compared to 27 children (controls) with high-grade vesicoureteric reflux (VUR) without IRR matched in gender, age and VUR grade. All patients received urinary antibioprophylaxis during observation and antireflux surgery was performed in children
At entry, IRR was a complication of 42 refluxing renal units (RRU), including 7 VUR grade 3, 17 grade 4 and 18 grade 5. VUR was revealed by UTI in 21/32 patients with IRR compared to 11/27 patients in the control group (chi square, p<0.05). DMSA score was not different between the 42 RRU with IRR (1.450.15) compared to the 44 high-grade (grade 3 and over) RRU without IRR
CONCLUSIONS In conclusion, the spontaneous evolution of IRR is more pejorative owing to a greater risk for urinary tract infection and a trend to increase renal scarring. With medical management the prognosis of high-grade VUR with IRR is not different from high-grade VUR without IRR.
From 12:28 to 12:31 # S16-4 (PP) CAN BLADDER FUNCTION CHARACTERISTICS BE RECOGNIZED IN A VCUG IN YOUNG CHILDREN WITH VESICOURETERAL REFLUX ¨ STRO ¨ M*, Ulla SILLE ´N* Karina FELBERG, Marc BACHELARD*, Sofia SJO ‘‘Children’s Memorial Health’’ Institute, Warsaw, POLAND - *Pediatric Uronephrologic Centre, Queen Silvia Children’s Hospital, Go¨teborg, SWEDEN
PURPOSE
MATERIAL AND METHODS
The aim of the study was to investigate if bladder function variables could be recognized as radiological signs in the VCUG in children with vesicoureteral reflux (VUR).
116 patients with high-grade VUR had videocystometry at median age 6, 21 and 39 months. X-ray films of the bladder was reviewed for size (big ¼ above the line between the iliac crests, small ¼ below the line between the lower ends of sacroiliac
junctions), pathology of the bladder wall (irregular, trabeculated, diverticula) and pathology of the bladder neck / proximal urethra (urethral sphincter closed with filling of the posterior urethra - PUF).
RESULTS In univariable Cox survival-time regression, the younger mean age at first UTI, bilateral and grade 4 to 5 VUR and hydronephrosis on
ESPU Programme 2008 initial ultrasonography significantly increased the risk of recurrent UTI (p<0.05). In multivariable analysis, high grade and bilateral VUR were associated with increased risk of recurrent UTI. Among them, the most significant factor was the grade of VUR (p¼0.009). In the group with recurrent UTI, 80 % of the patients presenting high grade VUR showed delayed contrast passage on VCUG, but the group with non-recurrent UTI did not. Urodynamic studies were performed on 11 infants with recurrent UTI and 2
showed decreased bladder capacity and 1 showed a large residual urine volume.
CONCLUSIONS In the first year of life, high grade and bilateral VUR significantly increased the risk of recurrent UTIs. The delayed contrast passage on VCUG was the most significant factor associated with increased risk of recurrent UTIs.
From 12:23 to 12:28 # S16-3 (O) EVOLUTION AND PROGNOSIS VALUE OF INTRARENAL REFLUX Georges AUDRY, Julia BOUBNOVA, Aline SERGENT-ALAOUI*, Georges DESCHENES, WITH SECTION FRANCAISE D’UROLOGIE PEDIATRIQUEy Hopital TROUSSEAU, Pediatric Surgery, Paris, FRANCE - *Hopital TROUSSEAU, Nuclear Medecine, Paris, FRANCE - yHopital Robert Debre, Pediatric Nephrology, Paris, FRANCE
PURPOSE The aim of this multicenter, prospective observational case-control study was to evaluate the prognostic significance of intrarenal reflux (IRR).
who got recurrent urinary tract infections (UTI). DMSA scan performed at study entry, by 18 and 36 months of follow-up was scored for each refluxing renal unit from 0 (normal) to 3 (severe).
RESULTS
(1.070.18; NS). During the follow-up, the incidence of UTI and new renal scars were similar between the two groups. In addition, 18/33 patients with IRR and 13/27 patients in the control group underwent anti-reflux surgery due to recurrent UTI (Chi-square NS).
MATERIAL AND METHODS Thirty three patients aged 0 to 3 years with IRR, followed during three years, were compared to 27 children (controls) with high-grade vesicoureteric reflux (VUR) without IRR matched in gender, age and VUR grade. All patients received urinary antibioprophylaxis during observation and antireflux surgery was performed in children
At entry, IRR was a complication of 42 refluxing renal units (RRU), including 7 VUR grade 3, 17 grade 4 and 18 grade 5. VUR was revealed by UTI in 21/32 patients with IRR compared to 11/27 patients in the control group (chi square, p<0.05). DMSA score was not different between the 42 RRU with IRR (1.450.15) compared to the 44 high-grade (grade 3 and over) RRU without IRR
CONCLUSIONS In conclusion, the spontaneous evolution of IRR is more pejorative owing to a greater risk for urinary tract infection and a trend to increase renal scarring. With medical management the prognosis of high-grade VUR with IRR is not different from high-grade VUR without IRR.
From 12:28 to 12:31 # S16-4 (PP) CAN BLADDER FUNCTION CHARACTERISTICS BE RECOGNIZED IN A VCUG IN YOUNG CHILDREN WITH VESICOURETERAL REFLUX ¨ STRO ¨ M*, Ulla SILLE ´N* Karina FELBERG, Marc BACHELARD*, Sofia SJO ‘‘Children’s Memorial Health’’ Institute, Warsaw, POLAND - *Pediatric Uronephrologic Centre, Queen Silvia Children’s Hospital, Go¨teborg, SWEDEN
PURPOSE
MATERIAL AND METHODS
The aim of the study was to investigate if bladder function variables could be recognized as radiological signs in the VCUG in children with vesicoureteral reflux (VUR).
116 patients with high-grade VUR had videocystometry at median age 6, 21 and 39 months. X-ray films of the bladder was reviewed for size (big ¼ above the line between the iliac crests, small ¼ below the line between the lower ends of sacroiliac
junctions), pathology of the bladder wall (irregular, trabeculated, diverticula) and pathology of the bladder neck / proximal urethra (urethral sphincter closed with filling of the posterior urethra - PUF).