Early identification of different categories of the risk of scarring in children with first (or follow up) urinary tract infection and/or early detection and treatment of vesicoureteral reflux are important to prevent kidney impairment. The demonstration and grading of reflux is crucial in examination and follow up of any child with urinary tract infection. Nephro-urologic radionuclide studies are able to detect vesicoureteral reflux and reflux nephropathy, such as radionuclide cystography--RNC--(both direct radionuclide voiding cystography--DRVC--and indirect radionuclide cystography-IRC), renal DMSA scintigraphy, MAG3 renal diuresis scintigraphy and DTPA renal diuresis scintigraphy. They allow to assess renal parenchyma integrity, to detect pyelonephritic scars, to evaluate the different aspects of urinary tract function and to measure absolute and relative function after intravenous injection of radiopharmaceuticals. The procedure, image acquisition and processing and the diagnostic relevance of all aforesaid nephro-urologic radionuclide studies are illustrated.
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Understanding and Managing Pediatric Urinary Tract Infections in Vesicoureteral Reflux: Insights Into Pathophysiology and Care.
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Vesicoureteral reflux (VUR) is a pediatric condition identified by the backward flow of urine from the bladder to one or both ureters and kidneys, predisposing patients to recurrent urinary tract infections (UTIs) and kidney scarring. Continuous antibiotic prophylaxis has long been a mainstay of management aimed at preventing recurrent UTIs and resulting renal damage. This review critically discusses the evidence supporting the utilization of antibiotic prophylaxis in VUR, with a focus on its efficacy, safety, long-term outcomes, and future directions in management.
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January 2025
Department of Pediatric Nephrology and Rheumatology, Dokuz Eylül University Medical Faculty, Izmir, Turkey.
Background: As voiding cystourethrography is invasive and exposes to radiation and urinary tract infection (UTI), identifying only high-grade reflux is important. We aimed to identify clinical, laboratory and imaging variables associated with high-grade primary reflux in children presenting with UTIs and/or urinary tract dilatation and develop a prediction model for severe reflux.
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Vesicoureteral reflux of a solitary kidney treated with endoscopic injection therapy comprising tandem injections administered with the assistance of a ureteral guidewire in a young girl.
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Division of Urology, Children's Hospital Los Angeles, USC Institute of Urology, Keck School of Medicine of USC, Los Angeles, CA, USA. Electronic address:
Background: The current gold-standard for detecting vesicoureteral reflux (VUR) is the voiding cystourethrogram (VCUG). However, VCUGs require ionizing radiation and bladder catheterization that can be challenging to perform and traumatic for pediatric patients and their parents.
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Predictability of success of endoscopic vesicoureteral reflux treatment utilizing clinical risk factors and intraoperative injection characteristics.
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Ege University, Faculty of Medicine, Department of Pediatric Surgery, Division of Pediatric Urology, TÜRKİYE.
Introduction: The guidelines lack clarity on how to follow the patients after endoscopic treatment for vesicoureteral reflux (VUR). The most discussed question is the need for voiding cystourethrogram (VCUG). Risk-based approaches that consider patient characteristics, disease severity, or factors related to the surgery itself could reduce its use, but a satisfactory predictive model has not yet been established.
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