Long Term Incidence of Urinary Tract Infection After

8/10/2019 Long Term Incidence of Urinary Tract Infection After

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LONG TERM INCIDENCE of URINARYTRACT INFECTION AFTER

ENDOSCOPIC MANAGEMENT of

VESICOURETERAL REFLUX

Jurnal Reading Bedah Urologi

25 Juni 2014Nugroho S / NOE


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Pediatric Urology, 2014. Adrianne M. Heckler

et al. Urology 83: 1383-1387. Elsevier. Inc.

http://dx.doi.org/10.1016/j.urology/2013.12.045.


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Introduction

Primary VUR : abn flow of urine from bladder

into ureter (renal pelvis in many case).

Present in children as UTI

Primary goals : prevent recurrent febrile

pyelonephritis & associated renal scarring

Gold std VUR (surgical): open ureteralreimplantation


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Objective

to evaluate long-term UTI rates after

endoscopic correction of VUR and the

possibilities risk factors for UTI


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Methods

Reviewing all px undergo endoscopic injection

for VUR at Oregon Health Science University

who treated between 2001-2011.

Secondary VUR is excluded.

Total px treated with VUR = 172 (3 px not

complete database).

Average age = 6 y.o

Range = 1-23 y.o


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67px of total 175 px was BBD.

All BBD px treat with modification (timed

voiding, micture alarm, pharmaceutical tx,

prophylaxis before and maintain after their

post op with VCUG).

Survey included px :

family preference - solitary kidney+VUR

febrile UTI - renal scarring (scan DMSA)

persistant VUR - renal insuffisiency

Px HIT - STING proc with endoscopic

repair of VUR


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Post op follow in 3 month with VCUG, USG,

Urinalysis.

1 year with assesment previously UTI perfoms

USG and Urinalysis.

>1 year: px with post op voiding disfunction,

renal insufficiency or persistent UTI.


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Quisionnaire


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UTI considered when confirmed with leukositesterase for +urynalisis in symptomatic px andurine culture >10,000 CFU/mL single

organism. Folow up time defined last visite or the date

quisionnaire completed.

Analysis statistic 1st

completed only when pxconfirmed UTI.

2ndanalysis completed on px reported an UTI.


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Result

175 px Range follow up 37 month (12-112month).

66 px returned quisionnaire.

Reflux range : grade II-IV (8 male; 157 female). 74% px had VUR resolution in 3 month.

86 px unilateral refluxing and 189 bilateralrefluxing ureters.

Reflux gr. IV = 19% Reflux gr. III = 51%

Reflux gr. II = 30%


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65% dari total px = infection.

19% nya disertai UTI febrile.

Px with higher preoperative UTIs (reported byquestionnaire) were also more likely to have

postoperative febrile UTIs on the basis of

questionnaire responses.


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Comment

Endoscopic become an popular option for the

txof VUR. Its allows parents to avoid long-term

prophylaxis for their children, without

committing surgical reconstruction. Randomized trials show 22% result post op UTI.

American Urological Association guidelines 2010

report an estimated 30% of open ureteralreimplant patients will experience cystitis & 10%

a febrile UTI.


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Void dysfc&BBD with reccurent UTI in child

didnt contributed in this study.

all patients presenting with BBD and

diagnosed with VUR were treated with

behavioral and pharmacologic interventions.

Management is maintained throughout their

treatment regimens and continued aftersurgery when warranted.


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Scarring on DMSA has also been shown to

correlate with recurrent UTIs.

Questionnaires were not completed on all the

patients.


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Conclusion

A significantly higher number of patients with

positive 1 year postprocedure VCUGs were

prone to recurrent UTIs.

These data show patients with more

preoperative UTIs continued to be at a higher

risk of a postoperative UTI.


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These results suggest a concern for recurrent

infections in patients undergoing this

proceduremost specifically in those with

reflux postprocedure or with a high incidenceof reprocedure UTIs.

This study does not answer the question of

whether the reflux is persistent or recurrent.

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Long Term Incidence of Urinary Tract Infection After