ESPN 51th Annual Meeting

ESPN 2018


 
MANAGEMENT OF CHILDREN WITH VESICO-URETERAL REFLUX (VUR) AT GENERAL HOSPITAL CELJE, SLOVENIA
KATARINA MESTROVIC POPOVIC 1 SPELA CAPUDER 1

1- GENERAL HOSPITAL CELJE
 
Introduction:

Vesico-ureteral reflux (VUR) is one of the main pathologies in pediatric nephrology. The recommendations for VUR recognition, methods for confirmation, follow-up and treatment have changed in the last years. Contrast-enhanced voiding urosonography (ce-VUS) is the most popular method for detection of VUR in our environment.

Material and methods:

We retrospectively evaluated the characteristics of patients referred to our nephrologic out-patient clinic in the period between January 2013 and September 2017. VUR classification was simplified to grade I - III for practical reasons.

Results:

We have performed 417 ce-VUS, 243 (58%) were negative. Of 174 children with VUR grade I - III (42% of investigations), 154 continued management within our hospital. These have altogether 227 refluxing units. Main indications for performing ce-VUS were urinary tract infections (73%), followed by congenital anomalies of the kidney and urinary tract (CAKUT) – most commonly pelvicalyceal dilatation (38%), amongst others were micturition disturbances, haematuria and positive family history of VUR. In the average grade I VUR was present in 3, 3% refluxing units, grade II VUR in 88, 6% and grade III VUR in 8, 1%. 40 children (26%) with grade II and III VUR were referred for endoscopic application of Vantris and 82, 5% were successful. All children had regular clinical check-ups, ultrasound examination and urine + urinary culture assessment. We followed current recommendations for antimicrobial prophylaxis in high risk children.

Conclusions:

Most children with VUR, apart from having urinary tract infections, also had pelvicalyceal dilatation. Most need conservative follow-up until spontaneous resolution of VUR. Success rate of endoscopic VUR treatment with Vantris is comparable and even better than reported. Individualised care of children with (suspected) VUR and nonpharmacological methods of lowering the discomfort during the ce-VUS has proved beneficiary in our management. Long-term follow up is necessary especially in children with known risk factors.