Primärer vesikoureteraler Reflux

Fazit

Ein VUR stellt in Abhängigkeit vom Refluxgrad einen Risikofaktor für die Entstehung pyelonephritischer Narben dar. Entscheidend für die Langzeitprognose ist die Vermeidung von Nierenparenchymschäden durch rezidivierende Pyelonephritiden. Die heute vielfältigen Behandlungsmöglichkeiten erlauben eine individualisierte, risiko-adaptierte Therapie des VUR. Die antibakterielle Infektionsprophylaxe gehört dabei ebenso zum Spektrum der Behandlungsoptionen wie die endoskopische oder offene operative Refluxkorrektur und ein ausschließliches „watchful waiting“. Der Refluxgrad ist bei weitem nicht mehr das alleinige Kriterium für Indikation und Auswahl der Therapie. Moderne Behandlungsstrategien berücksichtigen daneben Alter und Geschlecht, das Vorhandensein dysplastischer oder pyelonephritischer Nierenparenchymdefekte, die klinische Symptomatik, Blasenfunktionsstörungen und die Häufigkeit bzw. Schwere rezidivierender HWI.

• Literatur

• 1 Brandström P, Neveus T, Sixt R et al. The Swedish reflux trial in children: IV. Renal damage. J Urol 2010; 184: 292-297
• 2 Cascio S, Paran S, Puri P. Associated urological anomalies in children with unilateral renal agenesis. J Urol 1999; 162: 1081-1083
• 3 Lebowitz RL, Blickman JG. The coexistence of ureteropelvic junction obstruction and reflux. AJR Am J Roentgenol 1983; 140: 231-238
• 4 Singh-Grewal D, Macdessi J, Craig J. Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trials and observational studies. Arch Dis Child 2005; 90: 853-858
• 5 Wennerström M, Hansson S, Jodal U et al. Primary and acquired renal scarring in boys and girls with urinary tract infection. J Pediatr 2000; 136: 30-34
• 6 Ammenti A, Cataldi L, Chimenz R et al. Febrile urinary tract infections in young children: recommendations for the diagnosis, treatment and follow-up. Acta Paediatr 2012; 101: 451-457
• 7 Tullus K. Vesicoureteric reflux in children. Lancet 2015; 385: 371-379
• 8 Smellie JM, Jodal U, Lax H et al. Outcome at 10 years of severe vesicoureteric reflux managed medically: Report of the International Reflux Study in Children. J Pediatr 2001; 139: 656-663
• 9 Estrada Jr CR, Passerotti CC, Graham DA et al. Nomograms for predicting annual resolution rate of primary vesicoureteral reflux: results from 2,462 children. J Urol 2009; 182: 1535-1541
• 10 Faust WC, Diaz M, Pohl HG. Incidence of post-pyelonephritic renal scarring: a meta-analysis of the dimercapto-succinic acid literature. J Urol 2009; 181: 290-297; discussion 297-298
• 11 Swerkersson S, Jodal U, Sixt R et al. Relationship among vesicoureteral reflux, urinary tract infection and renal damage in children. J Urol 2007; 178: 647-651; discussion 650-651
• 12 Beetz R, Bachmann H, Gatermann S et al. [Urinary tract infections in infants and children -- a consensus on diagnostic, therapy and prophylaxis]. Urologe A 2007; 46: 112, 114-118, 120-123
• 13 Mori R, Lakhanpaul M, Verrier-Jones K. Diagnosis and management of urinary tract infection in children: summary of NICE guidance. BMJ 2007; 335: 395-397
• 14 American Academy of Pediatrics CoQI, Subcommittee on Urinary Tract Infection. Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months. Pediatrics 2011; 128: 595-610
• 15 Stein R, Dogan HS, Hoebeke P et al. Urinary Tract Infections in Children: EAU/ESPU Guidelines. Eur Urol 2015; 67: 546-558
• 16 AAP – Subcommittee on Urinary Tract Infection SCoQIaM. Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months. Pediatrics 2011; 128: 595-610
• 17 Hoberman A, Charron M, Hickey RW et al. Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med 2003; 348: 195-202
• 18 Suson KD, Mathews R. Evaluation of children with urinary tract infection--impact of the 2011 AAP guidelines on the diagnosis of vesicoureteral reflux using a historical series. J Pediatr Urol 2014; 10: 182-185
• 19 Nelson CP, Johnson EK, Logvinenko T et al. Ultrasound as a screening test for genitourinary anomalies in children with UTI. Pediatrics 2014; 133: e394-403
• 20 Riccabona M. Cystography in infants and children: a critical appraisal of the many forms with special regard to voiding cystourethrography. Eur Radiol 2002; 12: 2910-2918
• 21 Lebowitz RL, Olbing H, Parkkulainen KV et al. International system of radiographic grading of vesicoureteric reflux. International Reflux Study in Children. Pediatr Radiol 1985; 15: 105-109
• 22 Darge K, Moeller RT, Trusen A et al. Diagnosis of vesicoureteric reflux with low-dose contrast-enhanced harmonic ultrasound imaging. Pediatr Radiol 2005; 35: 73-78
• 23 Liao PF, Ku MS, Tsai JD et al. Comparison of procalcitonin and different guidelines for first febrile urinary tract infection in children by imaging. Pediatr Nephrol 2014; 29: 1567-1574
• 24 Routh JC, Grant FD, Kokorowski PJ et al. Economic and radiation costs of initial imaging approaches after a child’s first febrile urinary tract infection. Clin Pediatr (Phila) 2012; 51: 23-30
• 25 Leroy S, Romanello C, Galetto-Lacour A et al. Procalcitonin is a predictor for high-grade vesicoureteral reflux in children: meta-analysis of individual patient data. J Pediatr 2011; 159: 644-651.e4
• 26 Ehrich JH, Schiffer E, Drube J. [Urinary proteomics: the diagnostic key for urinary tract abnormalities and kidney diseases in children?]. Urologe A 2011; 50: 170-179
• 27 Montini G, Hewitt I. Urinary tract infections: to prophylaxis or not to prophylaxis?. Pediatr Nephrol 2009; 24: 1605-1609
• 28 Craig JC, Simpson JM, Williams GJ et al. Antibiotic prophylaxis and recurrent urinary tract infection in children. N Engl J Med 2009; 361: 1748-1759
• 29 Hoberman A, Greenfield SP, Mattoo TK et al. Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med 2014; 370: 2367-2376
• 30 Brandström P, Esbjörner E, Herthelius M et al. The Swedish reflux trial in children: I. Study design and study population characteristics. J Urol 2010; 184: 274-279
• 31 Brandström P, Esbjörner E, Herthelius M et al. The Swedish Reflux Trial in Children: III. Urinary Tract Infection Pattern. J Urol 2010; 184: 286-291
• 32 Craig JC, Williams GJ, Hodson EM. Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med 2014; 371: 1070
• 33 Garin EH, Olavarria F, Garcia Nieto V et al. Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study. Pediatrics 2006; 117: 626-632
• 34 Montini G, Rigon L, Zucchetta P et al. Prophylaxis after first febrile urinary tract infection in children? A multicenter, randomized, controlled, noninferiority trial. Pediatrics 2008; 122: 1064-1071
• 35 Pennesi M, Travan L, Peratoner L et al. Is antibiotic prophylaxis in children with vesicoureteral reflux effective in preventing pyelonephritis and renal scars? A randomized, controlled trial. Pediatrics 2008; 121: e1489-1494
• 36 Roussey-Kesler G, Gadjos V, Idres N et al. Antibiotic prophylaxis for the prevention of recurrent urinary tract infection in children with low grade vesicoureteral reflux: results from a prospective randomized study. J Urol 2008; 179: 674-679; discussion 679
• 37 Brandström P, Esbjörner E, Herthelius M et al. The Swedish reflux trial in children: III. Urinary tract infection pattern. J Urol 2010; 184: 286-291
• 38 Reddy P, Evans MT, Hughes PA. Antimicrobial prophylaxis with vesico-ureteral reflux: a randomized prospective study of continuous therpay vs. intermittent therapy vs. surveillance. Pediatrics 1997; 100: 555
• 39 Finnell SM, Carroll AE, Downs SM. Technical Report--Diagnosis and Management of an Initial UTI in Febrile Infants and Young Children. Pediatrics 2011; 128: e749-770
• 40 Peters CA, Skoog SJ, Arant Jr BS et al. Summary of the AUA Guideline on Management of Primary Vesicoureteral Reflux in Children. J Urol 2010; 184: 1134-1144
• 41 Alconcher LF, Meneguzzi MB, Buschiazzo R et al. Could prophylactic antibiotics be stopped in patients with history of vesicoureteral reflux?. J Pediatr Urol 2009; 5: 383-388
• 42 Moriya K, Mitsui T, Kitta T et al. Early discontinuation of antibiotic prophylaxis in patients with persistent primary vesicoureteral reflux initially detected during infantile period: Outcome analysis and risk factors for febrile urinary tract infection. J Urol 2015; 193: 637-642
• 43 Al-Sayyad AJ, Pike JG, Leonard MP. Can prophylactic antibiotics safely be discontinued in children with vesicoureteral reflux?. J Urol 2005; 174: 1587-1589; discussion 1589
• 44 Thompson RH, Chen JJ, Pugach J et al. Cessation of prophylactic antibiotics for managing persistent vesicoureteral reflux. J Urol 2001; 166: 1465-1469
• 45 Cooper CS, Chung BI, Kirsch AJ et al. The outcome of stopping prophylactic antibiotics in older children with vesicoureteral reflux. J Urol 2000; 163: 269-272; discussion 272-273
• 46 Georgaki-Angelaki H, Kostaridou S, Daikos GL et al. Long-term follow-up of children with vesicoureteral reflux with and without antibiotic prophylaxis. Scand J Infect Dis 2005; 37: 842-845
• 47 Hensle TW, Hyun G, Grogg AL et al. Part 2: Examining pediatric vesicoureteral reflux: a real-world evaluation of treatment patterns and outcomes. Curr Med Res Opin 2007; 23: S7-S13
• 48 Yiee JH, Baskin LS, Patel N et al. Prospective blinded laboratory assessment of prophylactic antibiotic compliance in a pediatric outpatient setting. J Urol 2012; 187: 2176-2181
• 49 Beetz R. Rezidivprophylaxe bei Harnwegsinfektionen – noch zeitgemäß?. Pädatrie up2date 2011; 6: 179-196
• 50 Bael AM, Benninga MA, Lax H et al. Functional urinary and fecal incontinence in neurologically normal children: symptoms of one ‘functional elimination disorder’. BJU Int 2007; 99: 407-412
• 51 Thompson M, Simon SD, Sharma V et al. Timing of follow-up voiding cystourethrogram in children with primary vesicoureteral reflux: development and application of a clinical algorithm. Pediatrics 2005; 115: 426-434
• 52 Tekgul S, Riedmiller H, Hoebeke P et al. EAU guidelines on vesicoureteral reflux in children. Eur Urol 2012; 62: 534-542
• 53 Riedmiller H, Gerharz EW. Antireflux surgery: Lich-Gregoir extravesical ureteric tunnelling. BJU Int 2008; 101: 1467-1482
• 54 Stein R, Rubenwolf P, Ziesel C et al. Psoas hitch and Boari flap ureteroneocystostomy. BJU Int 2013; 112: 137-155
• 55 Kirsch AJ, Arlen AM, Lackgren G. Current trends in dextranomer hyaluronic acid copolymer (Deflux) injection technique for endoscopic treatment of vesicoureteral reflux. Urology 2014; 84: 462-468
• 56 Lee EK, Gatti JM, Demarco RT et al. Long-term followup of dextranomer/hyaluronic acid injection for vesicoureteral reflux: late failure warrants continued followup. The Journal of urology 2009; 181: 1869-1874; discussion 1874-1875
• 57 Brandström P, Jodal U, Sillen U et al. The Swedish reflux trial: review of a randomized, controlled trial in children with dilating vesicoureteral reflux. Journal of pediatric urology 2011; 7: 594-600
• 58 BirminghamRefluxStudyGroup. Prospective trial of operative versus non-operative treatment of severe vesicoureteric reflux in children: five years' observation. Birmingham Reflux Study Group. Br Med J (Clin Res Ed) 1987; 295: 237-241
• 59 Olbing H, Smellie JM, Jodal U et al. New renal scars in children with severe VUR: a 10-year study of randomized treatment. Pediatr Nephrol 2003; 18: 1128-1131
• 60 Beetz R, Mannhardt W, Fisch M et al. Long-term followup of 158 young adults surgically treated for vesicoureteral reflux in childhood: the ongoing risk of urinary tract infections. J Urol 2002; 168: 704-707; discussion 707
• 61 Mackie GG, Stephens FD. Duplex kidneys: a correlation of renal dysplasia with position of the ureteral orifice. J Urol 1975; 114: 274-280
• 62 Beetz R, Mannhardt-Laakmann W, Schofer O. Kinderurologische Sprechstunde Orientierungshilfen für die Praxis. Stuttgart: Wissenschaftliche Verlagsgesellschaft mbH; 1998