Primary vesicoureteral reflux.

Autor: Puri P; University College Dublin, Dublin, Ireland. prof.prempuri@gmail.com., Friedmacher F; Department of Paediatric Surgery and Paediatric Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany., Farrugia MK; Department of Paediatric Urology, Chelsea and Westminster Hospital (West London Children's Healthcare), London, UK.; Imperial College, London, UK., Sharma S; Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India., Esposito C; Division of Paediatric Surgery, Federico II University Hospital, Naples, Italy., Mattoo TK; Departments of Paediatrics (Nephrology) and Urology, Wayne State University School of Medicine, Detroit, MI, USA.
Jazyk: angličtina
Zdroj: Nature reviews. Disease primers [Nat Rev Dis Primers] 2024 Oct 10; Vol. 10 (1), pp. 75. Date of Electronic Publication: 2024 Oct 10.
DOI: 10.1038/s41572-024-00560-8
Abstrakt: Primary vesicoureteral reflux (VUR) is one of the most common urological abnormalities in infants and children. The association of VUR, urinary tract infection (UTI) and renal parenchymal damage is well established. The most serious complications of VUR-associated reflux nephropathy are hypertension and proteinuria with chronic kidney disease. Over the past two decades, our understanding of the natural history of VUR has improved, which has helped to identify patients at increased risk of both VUR and VUR-associated renal injury. The main goals in the treatment of paediatric patients with VUR are the prevention of recurrent UTIs and minimizing the risk of renal scarring and long-term renal impairment. Currently, there are four options for managing primary VUR in infants and children: surveillance or intermittent treatment of UTIs with management of bladder and bowel dysfunction; continuous antibiotic prophylaxis; endoscopic subureteral injection of tissue-augmenting substances; and ureteral reimplantation via open, laparoscopic or robotic-assisted surgery. Current debates regarding key aspects of management include when to perform diagnostic imaging and how to best identify the paediatric patients that will benefit from continuous antibiotic prophylaxis or surgical intervention, including endoscopic injection therapy and minimally invasive ureteral reimplantation. Evolving technologies, such as artificial intelligence, have the potential to assist clinicians in the decision-making process and in the individualization of diagnostic imaging and treatment of infants and children with VUR in the future.
(© 2024. Springer Nature Limited.)
Databáze: MEDLINE
Externí odkaz: