Stories about: vesicoureteral reflux

VUR updates: Q&A with a pediatric urologist

VUR-leadThe American Urological Association (AUA) recently reviewed and validated the 2010 clinical guidelines, Management and Screening of Primary Vesicoureteral Reflux (VUR) in Children.

Although the guidelines remain intact, the AUA expanded its scope to include guidelines for the screening of siblings of children with VUR and of infants diagnosed prenatally with hydronephrosis.

Boston Children’s Urologist and Director of Quality and Safety, Caleb Nelson, MD, MPH, provides guidance on the detection and treatment of reflux in children, and offers clinical insight on the screening of siblings and those diagnosed prenatally with hydronephrosis. …Read More

Clinical Consult: Weighing the risks and benefits of Deflux for reflux

vesicoureteral reflux VUR deflux Dx/HA

It’s estimated that one in three children with recurrent urinary tract infections have vesicoureteral reflux (VUR), a urological condition where urine flows backwards from the bladder to the kidney.

Though the condition’s management has evolved, the question of which treatment is the preferred one — and specifically, whether urologists should continue to turn to endoscopic injections of dextranomer/hyaluronic acid copolymer (Dx/HA, aka Deflux) — remains a source of debate.

Boston Children’s Urologist-in-Chief, David Diamond, MD and colleagues Alan B. Retik, MD and Stuart B. Bauer, MD, researched Dx/HA use, and determined that due to its:

  1. high failure rate
  2. long-term complication rate
  3. high re-treatment rate
  4. high (and rising) cost

the risks of Dx/HA far outweigh its limited benefits in a majority of patients.

Read Boston Children’s “Caution in Employing Deflux for Reflux – The Thinking Behind Our Approach” white paper and find out why our urology experts say Dx/HA should not be considered as a preferred treatment option for children with VUR.

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Challenging Case: UTI and undetected genitourinary anomalies

MRI solid kidney vesicoureteral reflux hydronephrosis
MRI revealing the lack of a right kidney, as well as hydronephrosis of the left kidney.

A 3-year-old boy initially presented with a 10-day history of intermittent fevers—fluctuating as high as 105°F—and abdominal pain. His abdominal pain was episodic (lasting 30-60 minutes and occurring 2-3 times per day) fairly severe, peri-umbilical, non-radiating, and worsened with fevers. Initial evaluation revealed largely unremarkable labs (wbc 11.3, urinalysis normal). The patient was admitted to the hospital overnight but cultures and other workup were negative. No imaging was obtained at that time. As his fevers and abdominal pain resolved during the hospital stay, he was discharged home with presumed diagnosis of sequential viral infections.

Three days later he presented again a fever of 104°F and recurrent abdominal pain. Urinalysis and cultures were again negative. This time, abdominal sonography was obtained, showing a solitary left kidney with hydroureteronephrosis and a cystic area posterior to the bladder. The Boston Children’s Hospital Department of Urology was called into consult, after which an MRI confirmed right renal agenensis, left hydroureteronephrosis and a presumed right seminal vesicle cyst. …Read More

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