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The incidence of recurrent UTI in children with grade II - III VUR - Research Paper Example

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The incidence of recurrent UTI in children with grade II - III VUR

Secondary VUR occurs when an obstruction anywhere in the urinary tract occurs due to injury, torsion or anatomical abnormality. Treatment strategies are oriented around antibiotic therapy and surgical correction of the precipitating anatomical abnormalities. As VUR is a heterogeneous disorder, treatment strategies tried hitherto are still controversial as the disorder represents one of the most significant risk factors for acute pyelonephritis and subsequent kidney disease in children, characterized later by the manifestation of renal parenchymal injury, hypertension and chronic renal insufficiency which may be life threateneing (Cooper, 2009). Antibiotic prophylaxis in prone children has been the hallmark of therapeutic strategy against VUR till date. Incidence of repeated UTI infections in infants and young children are indicative of VUR and antibiotic therapy is initiated after confirmation of the diagnosis through cystourethrogram and ultrasound studies (NIH). The American Urological Association recommends continuous antibiotic therapy in young children once UTI infection has been diagnosed, and primary VUR grade III-V has been established. Latest research however reveals skepticism for this approach. Studies have indicated that antibiotic prophylaxis does not reduce the recurrence rate of pyelopnephritis and incidence of renal damage in children younger than 30 months of age diagnosed with VUR grade II through IV (Pennessi et al, 2011). Surgical intervention is recommended only when there has been no improvement in symptoms within one year (NIH). Secondary VUR is better amenable to treatment using surgical interventions for removing the obstruction. Current indications for the surgical correction of VUR depend on the presence or absence of renal scars. If no scars are present, anti reflux surgery is only indicated in high-grade bilateral VUR. Imaging studies for the diagnosis of VUR in children reveal that there is a good correlation between detection of renal scarring and existence of VUR in children aged less than one year, however the focus of imaging in older children should be the kidney as detection of reflux had a poor correlation with scarring (Gleeson & Gordon, 1991). Renal ultrasound studies have also failed to demonstrate sensitivity as well as specificity in detecting VUR in children diagnosed with UTI for the first time (Mahant et al, 2002). It has now been established that most children diagnosed with VUR do not improve with the currently available therapeutic modalities and treatment needs to be individualized according to peculiarities of a particular case (Cooper, 2009). Endoscopic subureteral injection of a dextranomer/hyaluronic acid copolymer has been suggested as an alternative therapeutic intervention, which is minimally invasive, can be carried out as an outpatient procedure with minimal rate of complications (Cooper, 2009). Initial studies have pointed out that the procedure has a success rate of 59-95% per treated ureter, with a much better prognosis after the second injection. Recommended for VUR grades II through IV, the compound is injected at the junction of the ureter with the bladder, where it prevents the retrograde flow of urine. Another study shows that the subureteral injection of polydimethylsiloxane showed a success rate of 82.3% on the first injection, and 98% after ...Show more
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RESEARCH PROPOSAL NAME: First and last name DATE: October X PROJECT TITLE: Incidence of Recurrent UTI in Children Diagnosed with VUR INTRODUCTION: Vesicoureteral reflux (VUR) is retrograde flow of urine from the bladder through the ureters towards the kidneys, which may lead to infection, damage and permanent scarring of the kidneys, hindering the excretory process initially, and leading to grave consequences if not treated appropriately…
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