For more than 2 decades a major problem in pediatric urology has been the medical and surgical management of vesicoureteral reflux. Many effective surgical procedures have been advocated and used. A new surgical technique, particularly effective in patients with megatrigone, has been used in 38 children and adults with excellent results. The technique involves a single stitch that imbricates th...

Vesico-ureteral reflux (VUR) is presented in approximately %1 of children and is associated with an increased risk of pyelonephritis and renal scarring. Despite its prevalence and morbidity, many aspects of VUR diagnosis and treatment are controversial. We objectively assessed the published data; the data base for many current diagnoses and treatment patterns of VUR is limited. Recent studies h...

OBJECTIVES Although minimally invasive procedures have created a groundswell, supportive of early intervention as on expedient alternative to surveillance, we present a patient-driven model of care that weighs risk and benefit for each individual. METHODS A practice review was performed for the period 2000-2006. The records of all patients diagnosed by, or referred to, our group (three full-t...

There are many ongoing controversies surrounding vesicoureteral reflux (VUR). These include variable aspects of this common congenital anomaly. Lack of evidence-based recommendations has prolonged the debate. Systematic reviews (SRs) and meta-analysis (MA) are considered high-level evidence. The purpose of this review article is to summarize and critically appraise the available SR/MA pertainin...

The current literature suggests that multiple variables affect vesicoureteric reflux (VUR) resolution rates following dextranomer/hyaluronic acid copolymer (Dx/HA) injection. This article reviews the evidence pertaining to the effect of injected Dx/HA volume on success rates following endoscopic correction. Lack of prospective studies which use injected volume as a continuous variable coupled w...

Controversy and lack of consensus have been encountered in the management of pediatric urinary tract infection (UTI), including its diagnosis, radiological investigations and the use of antibiotic therapy. In this review, we discuss the need for radiological investigations and the extent of their use as well as the need for prophylactic antibiotics in children with UTI and vesicoureteral reflux...

The prevalence of vesicoureteral reflux (VUR) has been estimated as 0.4 to 1.8% among the pediatric population. In children with urinary tract infection, the prevalence is typically from 30-50% with higher incidence occurring in infancy. When correction of VUR is determined to be necessary, traditionally open ureteral reimplantation by a variety of techniques has been the mainstay of treatment....

BACKGROUND The invasiveness and exposure to radiation in voiding cystourethrography led to the introduction of alternative methods of diagnosis of vesicoureteral reflux, including contrast enhanced voiding urosonography. While there is a limited number of studies comparing these methods using new generation ultrasound contrast agents, none of them compared both methods simultaneously. This stud...

Measurement of IgG antibodies to Tamm-Horsfall protein (ATHA) in 92 bacteriuric schoolgirls aged 5-12 did not show a significant rise compared with the titres found in the sera of 24 healthy controls. ATHA titres showed no correlation with the presence of vesicoureteric reflux or kidney scarring and it is concluded that measurement of serum ATHA is of no value as a screening procedure for the d...

Thirty children were studied using both direct (catheter) and indirect techniques of radionuclide cystography. Of 54 ureters able to be compared, six showed vesico-ureteric reflux (VUR) on the direct study but were read as negative on the indirect cystogram, and five showed no reflux on the direct cystogram but were read as positive for VUR on the indirect study. (Sensitivity of 68% and specifi...