Korean J Urogenit Tract Infect Inflamm.  2014 Apr;9(1):34-38. 10.14777/kjutii.2014.9.1.34.

Incidence and Risk Factors of Urinary Tract Infection after Endoscopic Therapy for Vesicoureteral Reflux in Children

Affiliations
  • 1Department of Urology, Pusan National University Children Hospital, Yangsan, Korea. lsd@pusan.ac.kr
  • 2Department of Urology, Pusan National University School of Medicine, Yangsan, Korea.

Abstract

PURPOSE
The purpose of this study is to evaluate the incidence and risk factors of febrile urinary tract infection (UTI) after endoscopic therapy for vesicoureteral reflux (VUR).
MATERIALS AND METHODS
Analysis of the clinical data of 88 children (128 refluxing renal units; male 60%, female 40%) in a single institution during March 2011-June 2013 including age, gender, sorts and volume of agent for injection, preoperative VUR grade, recurrent UTI, bladder dysfunction, nephropathy, postoperative VUR, urinalysis, and urine culture results was performed retrospectively. All patients were followed for three to 62 months (average 25 months).
RESULTS
After the first injection, the complete resolutions rate of VUR (by ureter) was 72.7%, consisting of grade I 4 (90%), grade II 11 (84.6%), grade III 29 (76.3%), grade IV 33 (66%), and grade V 93 (72.7%) ureters. Preoperative UTI and febrile UTI were present in 81 (92.0%) and 49 patients (55.7%), respectively. Preoperative recurrent UTI and febrile UTI were observed in 53 (60.2%) and 30 patients (34.1%), respectively. Postoperative UTI and febrile UTI occurred in eight (9.1%) and in five patients (5.7%), respectively. In multivariate analysis, only preoperative recurrent UTI (odds ratio [OR], 0.17; p=0.04) and bladder trabeculation (OR, 0.104; p=0.038) were independent variables after endoscopic therapy.
CONCLUSIONS
Our data support that the successful endoscopic correction of VUR is associated with a low incidence of febrile UTI. The highest risk factor for post injection UTI is preoperative recurrent UTI and bladder dysfunction. Therefore, patients with preoperative recurrent UTI and bladder dysfunction require careful observation after endoscopic therapy for VUR.

Keyword

Urinary tract infections; Vesicoureteral-reflux; Endoscopic theraphy

MeSH Terms

Child*
Female
Humans
Incidence*
Male
Multivariate Analysis
Retrospective Studies
Risk Factors*
Ureter
Urinalysis
Urinary Bladder
Urinary Tract Infections*
Vesico-Ureteral Reflux*

Reference

1. Jacobson SH, Hansson S, Jakobsson B. Vesicoureteric reflux: occurrence and longterm risks. Acta Paediatr Suppl. 1999; 88:22–30.
Article
2. Elmore JM, Kirsch AJ, Heiss EA, Gilchrist A, Scherz HC. Incidence of urinary tract infections in children after successful ureteral reimplantation versus endoscopic dextranomer/hyaluronic acid implantation. J Urol. 2008; 179:2364–7.
Article
3. Smellie JM, Barratt TM, Chantler C, Gordon I, Prescod NP, Ransley PG, et al. Medical versus surgical treatment in children with severe bilateral vesicoureteric reflux and bilateral nephropathy: a randomised trial. Lancet. 2001; 357:1329–33.
Article
4. Hoberman A, Charron M, Hickey RW, Baskin M, Kearney DH, Wald ER. Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med. 2003; 348:195–202.
Article
5. Wadie GM, Moriarty KP. The impact of vesicoureteral reflux treatment on the incidence of urinary tract infection. Pediatr Nephrol. 2012; 27:529–38.
Article
6. Elder JS, Diaz M, Caldamone AA, Cendron M, Greenfield S, Hurwitz R, et al. Endoscopic therapy for vesicoureteral reflux: a metaanalysis. I. Reflux resolution and urinary tract infection. J Urol. 2006; 175:716–22.
Article
7. Baek M, Kim KD. Current surgical management of vesicoureteral reflux. Korean J Urol. 2013; 54:732–7.
Article
8. Traxel E, DeFoor W, Reddy P, Sheldon C, Minevich E. Risk factors for urinary tract infection after dextranomer/hyaluronic acid endoscopic injection. J Urol. 2009; 182(4 Suppl):1708–12.
Article
9. Chi A, Gupta A, Snodgrass W. Urinary tract infection following successful dextranomer/hyaluronic acid injection for vesicoureteral reflux. J Urol. 2008; 179:1966–9.
Article
10. Biočić M, Todorić J, Budimir D, Cvitković Roić A, Pogorelić Z, Jurić I; I, et al. Endoscopic treatment of vesicoureteral reflux in children with subureteral dextranomer/hyaluronic acid injection: a single-centre, 7-year experience. Can J Surg. 2012; 55:301–6.
Article
11. Chung PH, Lan LC, Wong KK, Tam PK. Deflux injection for the treatment of vesicoureteric reflux in children–a single centre's experience. Asian J Surg. 2009; 32:163–6.
Article
12. O'Donnell B, Puri P. Treatment of vesicoureteric reflux by endoscopic injection of Teflon. Br Med J. 1984; 289:7–9.
13. Hunziker M, Mohanan N, D'Asta F, Puri P. Incidence of febrile urinary tract infections in children after successful endoscopic treatment of vesicoureteral reflux: a longterm followup. J Pediatr. 2012; 160:1015–20.
Article
14. Fenton JJ, Mirza SK, Lahad A, Stern BD, Deyo RA. Variation in reported safety of lumbar interbody fusion: influence of industrial sponsorship and other study characteristics. Spine (Phila Pa 1976). 2007; 32:471–80.
15. Peters CA, Skoog SJ, Arant BS Jr, Copp HL, Elder JS, Hudson RG, et al. Summary of the aua guideline on management of primary vesicoureteral reflux in children. J Urol. 2010; 184:1134–44.
Article
16. Jodal U, Koskimies O, Hanson E, Löhr G, Olbing H, Smellie J, et al. Infection pattern in children with vesicoureteral reflux randomly allocated to operation or longterm antibacterial prophylaxis. The International Reflux Study in Children. J Urol. 1992; 148:1650–2.
17. Beetz R, Mannhardt W, Fisch M, Stein R, Thüroff JW. Longterm followup of 158 young adults surgically treated for vesicoureteral reflux in childhood: the ongoing risk of urinary tract infections. J Urol. 2002; 168:704–7. discussion 707.
Article
18. Läckgren G, Wåhlin N, Sköldenberg E, Stenberg A. Longterm followup of children treated with dextranomer/hyaluronic acid copolymer for vesicoureteral reflux. J Urol. 2001; 166:1887–92.
19. Chi A, Gupta A, Snodgrass W. Urinary tract infection following successful dextranomer/hyaluronic acid injection for vesicoureteral reflux. J Urol. 2008; 179:1966–9.
Article
20. Traxel E, DeFoor W, Reddy P, Sheldon C, Minevich E. Risk factors for urinary tract infection after dextranomer/hyaluronic acid endoscopic injection. J Urol. 2009; 182(4 Suppl):1708–12.
Article
21. Elmore JM, Kirsch AJ, Heiss EA, Gilchrist A, Scherz HC. Incidence of urinary tract infections in children after successful ureteral reimplantation versus endoscopic dextranomer/hyaluronic acid implantation. J Urol. 2008; 179:2364–7. discussion 2367-8.
Article
22. Wadie GM, Tirabassi MV, Courtney RA, Moriarty KP. The deflux procedure reduces the incidence of urinary tract infections in patients with vesicoureteral reflux. J Laparoendosc Adv Surg Tech A. 2007; 17:353–9.
Article
23. Puri P, Pirker M, Mohanan N, Dawrant M, Dass L, Colhoun E. Subureteral dextranomer/hyaluronic acid injection as first line treatment in the management of high grade vesicoureteral reflux. J Urol. 2006; 176:1856–9.
Article
24. Sedberry-Ross S, Rice DC, Pohl HG, Belman AB, Majd M, Rushton HG. Febrile urinary tract infections in children with an early negative voiding cystourethrogram after treatment of vesicoureteral reflux with dextranomer/hyaluronic acid. J Urol. 2008; 180(4 Suppl):1605–9. discussion 1610.
Article
25. Snodgrass W. Relationship of voiding dysfunction to urinary tract infection and vesicoureteral reflux in children. Urology. 1991; 38:341–4.
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