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1.
Actas urol. esp ; 43(5): 262-268, jun. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-181094

RESUMO

Objetivo: Identificar los resultados de la aplicación de polidimetilsiloxano en el manejo endourológico de reflujo vesicoureteral (RVU) sintomático al injerto renal y determinar factores asociados a la persistencia de los síntomas y del reflujo vesicoureteral. Material y métodos: Se incluyó a 23 pacientes con el diagnóstico de RVU sintomático en injerto renal evaluados de enero del 2010 a agosto del año 2018 en la Unidad Médica de Alta Especialidad # 14 de Veracruz, quienes recibieron aplicación endourológica de polidimetilsiloxano. Se realizó el análisis descriptivo, cuando fue posible se determinaron medidas de riesgo relativo para fracaso clínico (FC) con odds ratio (OR). Resultados: Del total de pacientes, 18 (78,3%) presentaron éxito clínico (EC). Se observó una diferencia significativa en la edad promedio (EC 30,61 ± 9,7, FC 46,0 ± 11,46; U de Mann-Whitney, p = 0,037) y en el número de episodios de pielonefritis aguda al injerto previos a la aplicación de PDMS (EC 2,27 ± 1,27, FC 3,6 ± 0,89; U de Mann-Whitney, p = 0,019). El patógeno más frecuente identificado fue la Escherichia coli, con un 45,4%. La resolución del RVU se observó en el 47,8% de los casos. Hubo una disminución del grado de RVU en el 73,9% de los casos. Se determinó como factor protector para FC la disminución del grado de RVU (OR: 0,031, IC del 95%: 0,002-0,437, con p = 0,008). Conclusiones: La aplicación endourológica de PDMS mostro ser útil en el manejo de los pacientes con RVU sintomático en injerto renal, disminuyendo el grado de RVU y permitiendo el EC en la mayoría de los casos


Objective: To identify the results of polydimethylsiloxane application in the endourological management of symptomatic vesicoureteral reflux to the kidney graft and to determine the factors associated with persistent symptoms and with vesicoureteral reflux. Material and methods: We included 23 patients diagnosed with symptomatic VUR in kidney graft, evaluated from January 2010 to August 2018 in the High Specialty Medical Unit # 14 in Veracruz. These patients received endourological application of polydimethylsiloxane. The descriptive analysis was carried out, and, if possible, the relative risk measures for clinical failure (CF) were determined with odds ratio (OR). Results: 18 (78.3%) patients presented clinical success (CS). There was a significant difference in the mean age (CS 30.61 ± 9.7, CF 46.0 ± 11.46; U Mann Whitney, P = .037), and in the number of episodes of AGPN prior to the application of PDMS (CS 2.27 ± 1.27, CF 3.6 ± 0.89, U Mann Whitney, P = .019). The most frequently identified pathogen was E. Coli, with 45.4%. VUR resolution was observed in 47.8% of the cases. There was a decreased degree of VUR in 73.9% of cases. A lower degree of VUR was determined as a protective factor for CF (OR: 0.031, 95% CI: 0.002-0.437, with P = .008). Conclusions: The endourological application of PDMS proved to be useful in the management of patients with symptomatic VUR in kidney graft, as it decreased the VUR degree and allowed CS in most cases


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Transplante de Rim , Refluxo Vesicoureteral/tratamento farmacológico , Dimetilpolisiloxanos/uso terapêutico , Epidemiologia Descritiva , Escherichia coli Uropatogênica/patogenicidade
2.
J Med Case Rep ; 13(1): 128, 2019 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-31053166

RESUMO

BACKGROUND: A bilateral duplex collecting system is an unusual renal tract abnormality. Vesicoureteral reflux may be associated. We describe a rare case of bilateral duplex collecting system with bilateral vesicoureteral reflux in which the refluxing ureter on the left side drains the upper pole moiety contrary to what is often found. CASE PRESENTATION: A 24-year-old married Arab woman presented with ascending left-sided flank pain during micturition. She complained of recurrent urinary tract infections. A physical examination and laboratory tests were normal. Voiding cystourethrography and computed tomography scan detected bilateral duplex collecting system, grade IV vesicoureteral reflux on the left side, and grade I vesicoureteral reflux on the right. She underwent left heminephrectomy and dextranomer/hyaluronic acid injections on the right side. After a year of follow-up, a clinical examination and imaging findings were unremarkable. CONCLUSIONS: A bilateral duplex collecting system with refluxing upper pole moiety ureter is a very rare entity. The diagnosis should be suspected when exploring any flank pain with recurrent urinary tract infections to avoid subsequent renal impairment. Furthermore, this case shows how some common symptoms may lead to finding an unexpected urinary tract abnormality.


Assuntos
Cistografia , Dextranos/uso terapêutico , Ácido Hialurônico/uso terapêutico , Túbulos Renais Coletores/fisiopatologia , Nefrectomia/métodos , Tomografia Computadorizada por Raios X , Refluxo Vesicoureteral/fisiopatologia , Feminino , Dor no Flanco , Humanos , Rim/anormalidades , Túbulos Renais Coletores/diagnóstico por imagem , Resultado do Tratamento , Ureter/anormalidades , Infecções Urinárias , Micção , Refluxo Vesicoureteral/diagnóstico por imagem , Refluxo Vesicoureteral/tratamento farmacológico , Adulto Jovem
3.
J Korean Med Sci ; 34(21): e156, 2019 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-31144480

RESUMO

BACKGROUND: Few studies have reported on breakthrough urinary tract infection (UTI) associated with the susceptibility of index UTI to prophylactic antibiotics in children with primary vesicoureteral reflux (VUR) receiving continuous antibiotic prophylaxis (CAP). We assessed the impact of the susceptibility of index UTI to prophylactic antibiotics in breakthrough UTIs in children with primary VUR receiving CAP. METHODS: We retrospectively reviewed the medical records of 81 children with primary VUR who were diagnosed after febrile or symptomatic UTI and subsequently received trimethoprim-sulfamethoxazole (TMP-SMX) as CAP between January 2010 and December 2013. We allocated children to a susceptible group or a resistant group based on the susceptibility of index UTI to TMP-SMX. We evaluated patient demographics and clinical outcomes after CAP according to the susceptibility of index UTI to TMP-SMX. Multivariate analysis was used to identify the predictive factors for breakthrough UTI. RESULTS: Of the 81 children, 42 were classified into the susceptible group and 39 into the resistant group. The proportion of breakthrough UTI was 31.0% (13/42) in the susceptible group and 53.8% (21/39) in the resistant group (P = 0.037). Progression of renal scarring was observed in 0% of children in the susceptible group and 15% in the resistant group (P = 0.053). Multivariate analysis showed that TMP-SMX resistance and initial renal scarring were significant predictors of breakthrough UTI. CONCLUSION: Susceptibility of index UTI to prophylactic antibiotics is a risk factor of breakthrough UTI and is associated with poor clinical outcomes in children with primary VUR receiving CAP.


Assuntos
Anti-Infecciosos Urinários/uso terapêutico , Antibioticoprofilaxia/métodos , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/prevenção & controle , Refluxo Vesicoureteral/tratamento farmacológico , Antibacterianos/uso terapêutico , Bactérias/classificação , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Combinação de Medicamentos , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Infecções Urinárias/microbiologia
4.
J Pediatr Surg ; 54(7): 1477-1480, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29871762

RESUMO

BACKGROUND/PURPOSE: The "European Association of Urology (EAU) Guidelines on Vesicoureteral Reflux (VUR) in Children (September 2012)" established risk classification by analyzing and defining risk factors for each patient. In this study we aimed to investigate how our initial treatment procedures were affected by EAU/ESPU guideline vesicoureteral reflux risk grouping and to compare the early clinical results of treatments performed before and after the risk classification in our patients with VUR. MATERIALS AND METHODS: 334 renal units with regular clinical follow-up who were treated owing to VUR (vesicoureteral reflux) between years 2009 and 2017 were retrospectively reviewed. Preoperative clinical parameters such as grade and laterality of reflux, presence of renal scar, initial and follow-up treatments, findings of medical treatment and surgical procedures were analyzed. The initial medical and surgical methods were compared by categorizing patients according to risk groups before and after 2013. RESULTS: Mean age and follow-up duration were 71.4(6-216) months and 47(4-141) months, respectively. Among the preoperative parameters, only high EAU risk group (p = 0.01) and treating lower urinary tract symptoms (p < 0.001) were determining the postoperative success rates significantly, while age, sex, and presence of renal scar at DMSA were not affecting the success of treatment significantly. While no significant difference in medical and surgical treatment rates is observed after risk grouping system in low risk group, the percentages of patients who are treated with surgical methods initially were significantly decreased in moderate and high risk groups (p = 0.002 and p = 0.012, respectively). We determined that VUR risk grouping did not change clinical success significantly in all risk groups. CONCLUSIONS: Despite the fact that EAU/ESPU VUR risk classification changed our current practice in terms of initial treatment method, this different approach did not seem to affect early clinical success positively. There is still an absolute need for studies with larger sample size and long-term follow-up to reach more reliable results. TYPE OF STUDY: Therapeutic. LEVEL OF EVIDENCE: Level 4.


Assuntos
Padrões de Prática Médica , Refluxo Vesicoureteral/tratamento farmacológico , Refluxo Vesicoureteral/cirurgia , Adolescente , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Resultado do Tratamento
6.
Pediatrics ; 142(1)2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29954832

RESUMO

CONTEXT: Limited data exist regarding uropathogen resistance in randomized controlled trials of urinary tract infection (UTI) prevention and antibiotic prophylaxis. OBJECTIVE: To assess the effect of prophylaxis on developing a multidrug-resistant first recurrent UTI among children with vesicoureteral reflux. DATA SOURCES: Cochrane Kidney and Transplant Specialized Register through May 25, 2017. STUDY SELECTION: Randomized controlled trials of patients ≤18 years of age with a history of vesicoureteral reflux being treated with continuous antibiotic prophylaxis compared with no treatment or placebo with available antibiotic sensitivity profiles. DATA EXTRACTION: Two independent observers abstracted data and assessed quality and validity per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Adjusted meta-analyses were performed by using a mixed-effects logistic regression model. RESULTS: One thousand two hundred and ninety-nine patients contributed 224 UTIs. Patients treated with prophylaxis were more likely to have a multidrug-resistant infection (33% vs 6%, P < .001) and were more likely to receive broad-spectrum antibiotics (68% vs 49%, P = .004). Those receiving prophylaxis had 6.4 times the odds (95% confidence interval: 2.7-15.6) of developing a multidrug-resistant infection. One multidrug-resistant infection would develop for every 21 reflux patients treated with prophylaxis. LIMITATIONS: Variables that may contribute to resistance such as medication adherence and antibiotic exposure for other illnesses could not be evaluated. CONCLUSIONS: Prophylaxis increases the risk of multidrug resistance among recurrent infections. This has important implications in the risk-benefit assessment of prophylaxis as a management strategy and in the selection of empirical treatment of breakthrough infections in prophylaxis patients.


Assuntos
Antibioticoprofilaxia/efeitos adversos , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Infecções Urinárias/microbiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Recidiva , Medição de Risco/métodos , Infecções Urinárias/tratamento farmacológico , Refluxo Vesicoureteral/complicações , Refluxo Vesicoureteral/tratamento farmacológico , Refluxo Vesicoureteral/microbiologia
7.
Int Braz J Urol ; 44(3): 585-590, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29522294

RESUMO

INTRODUCTION: Durasphere® EXP (DEXP) is a compound of biocompatible and non-biodegradable particles of zirconium oxide covered with pyrolytic carbon. The aim of this study is to evaluate the durability of off-label use of DEXP in the treatment of primary vesicoureteral reflux in children. MATERIALS AND METHODS: Patients who underwent subureteric injection of DEXP for the correction of primary VUR were retrospectively reviewed . Patients aged >18 years as well as those who had grade-I or -V VUR, anatomic abnormalities (duplicated system, hutch diverticulum), neurogenic bladder or treatment refractory voiding dysfunction were excluded. Radiologic success was defined as the resolution of VUR at the 3rd month control. Success was radiographically evaluated at the end of the first year. RESULTS: Thirty-eight patients (9 boys, 29 girls; mean age, 6.3±2.7 years) formed the study cohort. Forty-six renal units received DEXP (grade II: 22; grade III: 18; grade IV: 6). Mean volume per ureteric orifice to obtain the mound was 0.70±0.16mL. First control VCUG was done after 3 months in all patients. After the first VCUG, 6 patients had VUR recurrence. Short-term radiologic success of DEXP was 84.2%. Rate of radiologic success at the end of the first year was 69.4% (25/32). Lower age (p:0.006) and lower amount of injected material (p:0.05) were associated with higher success rates at the end of 1 year. CONCLUSION: This is the first study to assess the outcomes of DEXP for treatment of primary VUR in children. After 1 year of follow-up, DEXP had a 69.4% success rate.


Assuntos
Materiais Biocompatíveis/uso terapêutico , Glucanos/uso terapêutico , Refluxo Vesicoureteral/tratamento farmacológico , Zircônio/uso terapêutico , Criança , Pré-Escolar , Dextranos/uso terapêutico , Endoscopia/métodos , Feminino , Humanos , Ácido Hialurônico/uso terapêutico , Injeções , Masculino , Recidiva , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Resultado do Tratamento , Refluxo Vesicoureteral/cirurgia
8.
J Laparoendosc Adv Surg Tech A ; 28(3): 348-353, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29271690

RESUMO

OBJECTIVE: Vesicoureteral reflux (VUR) is a common condition associated with childhood urinary tract infection (UTI), which may lead to chronic renal failure and hypertension. Different antireflux approaches were advocated with differences in morbidity and success. The aim of this study is to review and analyze the surgical outcomes of pneumovesicoscopic ureteral reimplantation and endoscopic injection of dextranomer/hyaluronic acid (Dx/HA) in three tertiary centers. MATERIALS AND METHODS: The medical records of 215 patients (159 boys and 56 girls) for a total of 323 ureters underwent surgical interventions for primary VUR from February 2002 to August 2014 were reviewed. Data on baseline demographics, preoperative symptoms, radiological imaging studies, and postoperative outcomes were analyzed. VUR resolution was defined as when no VUR was detected by micturating cystourethrogram at 3 months or later after the intervention. Independent t-test, Mann-Whitney U test, Fisher's Exact test, and Chi-Square test were used for different parameters. All results with P value ≤.05 were regarded as statistically significant. RESULTS: The mean age at operation was 3.33 and 4.63 for reimplantation and Dx/HA injection respectively. A total of 234 ureters underwent Dx/HA injection and 92 ureters underwent pneumovesicoscopic ureteral reimplantation with mean preoperative VUR grading of 3.1 and 4.2 respectively (P = .0001). The overall VUR downgrading and resolution rates were both significantly higher in reimplantation than Dx/HA injection (97.8% versus 78.6% P = .0001 and 84.3% versus 65% P = .0011). Further subgroup analyses across the different VUR gradings showed higher downgrading and resolution rates in reimplantation group than Dx/HA injection for grade 4 (100% versus 81% P = .0147 and 82.4% versus 63% P = .0411) and grade 5 VUR (97.3% versus 50% P = .0022 and 81.6% versus 40% P = .0256). Dx/HA injection was associated with shorter operation time (41.5 minutes versus 147.5 minutes, P < .001), less postoperative analgesic usage (P = .049), and shorter hospital stay (1.06 days versus 4.44 days P < .0001). No major complications were identified in both groups. The mean follow-up time was significantly longer in reimplantation group than Dx/HA group (57.25 months versus 37.85 months, P = .002). There was no significant difference in the rate of subsequent UTI development during follow-up (P = .8). CONCLUSIONS: Both Dx/HA injection and pneumovesicoscopic ureteral reimplantation are safe and effective treatments for VUR. Reimplantation is associated with significantly higher VUR downgrading and resolution rates than Dx/HA injection especially in the higher grade VUR while Dx/HA injection has significantly shorter operation time, lower postoperative analgesic usage, and shorter hospital stay. Dx/HA injection can be considered as the first line surgical treatment especially for lower grade VUR. Pneumovesicoscopic ureteral reimplantation can be used for higher grade reflux or those who failed Dx/HA treatments.


Assuntos
Dextranos/administração & dosagem , Ácido Hialurônico/administração & dosagem , Ureter/cirurgia , Agentes Urológicos/administração & dosagem , Refluxo Vesicoureteral/tratamento farmacológico , Refluxo Vesicoureteral/cirurgia , Analgésicos/uso terapêutico , Pré-Escolar , Cistoscopia , Feminino , Humanos , Lactente , Injeções , Laparoscopia/métodos , Tempo de Internação , Masculino , Duração da Cirurgia , Dor Pós-Operatória/tratamento farmacológico , Reimplante/métodos , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Infecções Urinárias/etiologia , Infecções Urinárias/prevenção & controle , Refluxo Vesicoureteral/complicações
9.
J Assoc Physicians India ; 66(12): 68-72, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31315329

RESUMO

Vesicoureteral reflux (VUR) in children is often treated with antimicrobials for prolonged durations, which often leads to antimicrobial resistance. In this context, this review article discusses the use of endoscopic injection in VUR as a safe and efficacious option for these children. The literature pertaining to VUR- its clinical manifestation and management, antibiotic resistance- with special reference to management of VUR, and endoscopic dextranomer/hyaluronic acid gel injection for management of VUR was reviewed by identifying key words in a PubMed search. Vesicoureteral reflux is managed using antibiotic prophylaxis, urotherapy, or surgical correction (open, endoscopic injection therapy, or laparoscopic). Continuous antibiotic prophylaxis for urinary tract infections in VUR can lead to antibiotic resistance. Urotherapy cures about 75% of cases with dysfunctional voiding and the rest have to be managed at specialized centers. While open surgery provides relief of VUR and related complications in majority, it requires hospitalization. Endoscopic injection of dextranomer/hyaluronic acid gel into the submucosa of bladder or ureter near ureteral orifice increases the tissue bulk and creates a valve function. Various studies show the efficacy and safety of endoscopic injection of dextranomer/hyaluronic acid gel in VUR. The use of endoscopic injection being a non-invasive modality, can be performed in children with VUR in the outpatient department, precluding hospitalization. In view of the threat of developing antimicrobial resistance and also realising the need for definitive treatment of VUR, endoscopic injection is an efficacious and safe option in primary VUR.


Assuntos
Resistência Microbiana a Medicamentos , Refluxo Vesicoureteral/tratamento farmacológico , Criança , Humanos , Ácido Hialurônico , Estudos Retrospectivos , Ureter , Refluxo Vesicoureteral/microbiologia
10.
Urologe A ; 56(9): 1158-1163, 2017 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-28710643

RESUMO

Primary vesicoureteral reflux (VUR) is a dynamic disease with several factors influencing its course. Therapeutic options range from watchful waiting to open surgery. Multiple risk factors for the development of pyelonephritis are identified, which then determine the decision for the appropriate treatment option. They include age, gender, history of pyelonephritis and renal scarring, bladder and bowel dysfunction (BBD), circumcision status and parental preference. The use of continuous antibiotic prophylaxis (CAP) is becoming increasingly controversial with antibiotic resistance being a major concern. Aggressive treatment of BBD and infant circumcision can greatly reduce the risk for pyelonephritis and should always be considered and discussed. This article is soley concerned with primary VUR.


Assuntos
Antibioticoprofilaxia , Refluxo Vesicoureteral/cirurgia , Conduta Expectante , Farmacorresistência Bacteriana Múltipla , Humanos , Assistência de Longa Duração , Pielonefrite/prevenção & controle , Fatores de Risco , Infecções Urinárias/prevenção & controle , Refluxo Vesicoureteral/tratamento farmacológico , Refluxo Vesicoureteral/etiologia
11.
Eur J Pediatr ; 176(1): 1-9, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27888411

RESUMO

Ureteropelvic junction obstruction (UPJO) and vesicoureteral reflux (VUR) are the most common uropathies. The co-occurrence of both anomalies has led to the practice of screening for VUR in children with UPJO to prevent deterioration of kidney function due to renal scarring following urinary tract infections (UTIs). We determined the prevalence of VUR in children with UPJO for a critical assessment of VUR screening by voiding cystourethrography (VCUG). A systematic search strategy in MEDLINE, EMBASE, and CENTRAL was carried out for all articles that included VCUG, and renal scintigraphy or any other appropriate imaging technique for the diagnosis of UPJO. Twenty studies were eligible for inclusion. We found a pooled prevalence for VUR of 8.2 % (95 % CI = 3.6-12.7), about a threefold increase compared to the general pediatric population. VUR occurred bilateral or contralateral to the kidney with UPJO in 5.7 % (95 % CI = 3.0-8.5), equivalent to 75 % of all children with VUR. Considering the effect size of VUR treatment with antibiotics, about 207 and 278 children would need to undergo VCUG to prevent one febrile UTI and one case of renal scarring by 1-2 years, respectively. CONCLUSION: Against this background, screening for VUR needs to be scrutinized and restricted to selected risk groups. What is known: • Screening of patients with ureteropelvic junction obstruction (UPJO) for vesicoureteral reflux (VUR) is recommended based on a small number of repeatedly cited studies. • The lack of conclusive evidence results in different treatment strategies and leads to difficulties when communicating diagnoses and treatment options to parents. What is new: • A robust prevalence for VUR in children with UPJO based on all published evidence and the resulting number needed to screen are given for decision-making in daily clinical practice. • The results may be a precursor for implementation into guidelines.


Assuntos
Cistografia/efeitos adversos , Obstrução Ureteral/diagnóstico por imagem , Infecções Urinárias/prevenção & controle , Refluxo Vesicoureteral/diagnóstico por imagem , Adolescente , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Rim/anormalidades , Masculino , Estudos Retrospectivos , Obstrução Ureteral/complicações , Obstrução Ureteral/tratamento farmacológico , Refluxo Vesicoureteral/complicações , Refluxo Vesicoureteral/tratamento farmacológico
12.
Cas Lek Cesk ; 155(3): 31-4, 2016.
Artigo em Tcheco | MEDLINE | ID: mdl-27256146

RESUMO

Vesicoureteric reflux (VUR) is the most common congenital anomaly of the uropoetic system. The gold standard for its diagnosis is the voiding cystourethrogram. Sonographic cystourethrography is an alternative method for reflux detection, but it is still not used routinely. Static scintigraphy enables us to diagnose renal scarring reflux nephropathy (RN). While congenital RN is a result of prenatal kidney injury, acquired RN results from pyelonephritis-induced renal damage.Risk factors for RN include VUR, recurrent APN, lower urinary tract dysfunction and delay in treatment of febrile urinary tract infection. Management of children after APN with VUR consists of antibiotic prophylaxy, surgery or surveillance only. The conclusions of performed studies are controversial, thus unified guidelines for the management of patients with VUR are not available.


Assuntos
Antibioticoprofilaxia , Refluxo Vesicoureteral/diagnóstico , Refluxo Vesicoureteral/tratamento farmacológico , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Falência Renal Crônica/etiologia , Masculino , Fatores de Risco , Ultrassonografia , Infecções Urinárias/etiologia , Refluxo Vesicoureteral/complicações
13.
Pediatrics ; 137(4)2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26969273

RESUMO

BACKGROUND: The Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trial found that recurrent urinary tract infections (rUTI) with resistant organisms were more common in the trimethoprim-sulfamethoxazole prophylaxis (TSP) arm. We describe factors associated with trimethoprim-sulfamethoxazole (TMP-SMX) resistance of rUTIs in RIVUR. METHODS: Children aged 2 to 71 months with first or second UTI (index UTI) and grade I to IV vesicoureteral reflux (VUR) were randomized to TSP or placebo and followed for 2 years. Factors associated with TMP-SMX-resistant rUTI were evaluated. RESULTS: Among 571 included children, 48% were <12 months old, 43% had grade II VUR, and 38% had grade III VUR. Recurrent UTI occurred in 34 of 278 children receiving TSP versus 67 of 293 children receiving placebo. Among those with rUTI, 76% (26/34) of subjects receiving TSP had TMP-SMX-resistant organisms versus 28% (19/67) of subjects receiving placebo (P < .001). The proportion of TMP-SMX-resistant rUTI decreased over time: in the TSP arm, 96% were resistant during the initial 6 months versus 38% resistant during the final 6 months; corresponding proportions for the placebo arm were 32% and 11%. Among children receiving TSP, 7 (13%) of 55 with TMP-SMX-resistant index UTI had rUTI, whereas 27 (12%) of 223 with TMP-SMX-susceptible index UTI had rUTI (adjusted hazard ratio 1.38, 95% confidence interval 0.54-3.56). Corresponding proportions in placebo arm were 17 (26%) of 65 and 50 (22%) of 228 (adjusted hazard ratio 1.33, 95% confidence interval 0.74-2.38). CONCLUSIONS: Although TMP-SMX resistance is more common among children treated with TSP versus placebo, resistance decreased over time. Among children treated with TSP, there was no significant difference in UTI recurrence between those with TMP-SMX-resistant index UTI versus TMP-SMX-susceptible UTI.


Assuntos
Antibioticoprofilaxia , Farmacorresistência Bacteriana , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Infecções Urinárias/tratamento farmacológico , Refluxo Vesicoureteral/tratamento farmacológico , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Recidiva , Prevenção Secundária , Infecções Urinárias/etiologia , Refluxo Vesicoureteral/complicações
14.
J Pediatr Surg ; 51(8): 1366-9, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26882868

RESUMO

PURPOSE: Endoscopic dextranomer/hyaluronic acid copolymer (Dx/HA) injection is a safe and efficacious treatment option for vesicoureteral reflux (VUR) in children. Endoscopic appearance, hydrodistention and amount of injected Dx/HA have been demonstrated not to be reliable predictors of outcome. Aim of this study was to evaluate Dx/HA mounds on ultrasound scans (US) and find out any eventual correlation with reflux resolution. METHODS: We selected patients treated with endoscopic injection for moderate to high VUR, renal scaring or repeated infections under antibiotic prophylaxis. Success was defined by absence of VUR at control 3months after surgery; at 3months we also measured mound height ultrasonographically. RESULTS: We considered a total of 32 children (15 male, 17 female; 53 ureters) with a median age of 3years (±24months). Overall success rate was 77% per ureter. Success rate correlates directly with age and inversely with VUR grade. Mound height is the major predictive parameter for reflux resolution (sensitivity 100%, specificity 65.9%); mean mound heights of success-group vs. persistence-of-reflux group were 9.97±1.61mm and 7.29±1.74mm respectively (p<0.0005). CONCLUSION: A mound measuring at least 9.8mm at post-operative US scan is a predictor of reflux resolution. Age and grade also seems to influence success rate.


Assuntos
Dextranos/administração & dosagem , Endoscopia/métodos , Ácido Hialurônico/administração & dosagem , Refluxo Vesicoureteral/tratamento farmacológico , Viscossuplementos/administração & dosagem , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Injeções/métodos , Masculino , Período Pós-Operatório , Resultado do Tratamento , Ultrassonografia , Ureter/diagnóstico por imagem , Refluxo Vesicoureteral/diagnóstico por imagem
15.
J Pediatr ; 171: 116-21, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26794472

RESUMO

OBJECTIVE: To determine which children with urinary tract infection are likely to have pathogens resistant to narrow-spectrum antimicrobials. STUDY DESIGN: Children, 2-71 months of age (n = 769) enrolled in the Randomized Intervention for Children with Vesicoureteral Reflux or Careful Urinary Tract Infection Evaluation studies were included. We used logistic regression models to test the associations between demographic and clinical characteristics and resistance to narrow-spectrum antimicrobials. RESULTS: Of the included patients, 91% were female and 76% had vesicoureteral reflux. The risk of resistance to narrow-spectrum antibiotics in uncircumcised males was approximately 3 times that of females (OR 3.1; 95% CI 1.4-6.7); in children with bladder bowel dysfunction, the risk was 2 times that of children with normal function (OR 2.2; 95% CI 1.2-4.1). Children who had received 1 course of antibiotics during the past 6 months also had higher odds of harboring resistant organisms (OR 1.6; 95% CI 1.1-2.3). Hispanic children had higher odds of harboring pathogens resistant to some narrow-spectrum antimicrobials. CONCLUSIONS: Uncircumcised males, Hispanic children, children with bladder bowel dysfunction, and children who received 1 course of antibiotics in the past 6 months were more likely to have a urinary tract infection caused by pathogens resistant to 1 or more narrow-spectrum antimicrobials.


Assuntos
Anti-Infecciosos/farmacologia , Farmacorresistência Bacteriana , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia , Amoxicilina/farmacologia , Cefalosporinas/farmacologia , Criança , Pré-Escolar , Escherichia coli , Feminino , Humanos , Lactente , Enteropatias/tratamento farmacológico , Enteropatias/epidemiologia , Enteropatias/microbiologia , Masculino , Nitrofurantoína/farmacologia , Razão de Chances , Análise de Regressão , Sulfametoxazol/farmacologia , Trimetoprima/farmacologia , Infecções Urinárias/epidemiologia , Refluxo Vesicoureteral/tratamento farmacológico , Refluxo Vesicoureteral/epidemiologia , Refluxo Vesicoureteral/microbiologia
16.
Spinal Cord ; 54(1): 46-50, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26261074

RESUMO

OBJECTIVES: The objective of this study was to evaluate the effect and safety of trigonal injection of botulinum toxin A (BTX-A) for patients with neurological detrusor overactivity (NDO) with incontinence. METHODS: A prospective, multicenter, single-blind and randomized controlled trial was conducted between June 2011 and June 2014. Spinal cord injury patients with urinary incontinence secondary to NDO overactivity were recruited. At a 1:1 ratio, patients randomly received 200 U BTX-A intradetrusor injections excluding the trigone (the control group) or 160 U intradetrusor and 40 U intratrigonal injections (the experimental group). Patients were evaluated at baseline and at 4 and 12 weeks after injection. The efficacy and safety outcomes included Incontinence-Specific-Quality-of-Life Instrument (I-QoL), voiding volume, urinary incontinence episodes, complete dryness, maximum detrusor pressure (P(detmax)) and volume at first involuntary detrusor contraction (V(FIDC)). Vesicoureteral reflux (VUR) and other adverse events were recorded. RESULTS: Ninety-six patients were recruited and 91 of them completed the trial. Among the 91 patients, 47 were randomized to the experimental group and 44 to the control group. There were no significant differences in baseline evaluation items (gender, age, duration of spinal cord injury, level of neurological injury, AIS (the American Social Injury Association) scores) between the two groups. At 12 weeks, the improvement was significantly better in the experimental group compared with that in the control group for I-QoL (26.01 vs 18.75, P=0.01), mean urinary incontinence episodes (-5.22 vs -4.68 per day, P=0.01), complete dryness (13 vs 5, P=0.03), mean voiding volume (159.72 vs 139.07 ml, P=0.02), P(detmax) (-33.34 vs -28.02 cmH(2)O, P=0.04) and VFIDC (106.81 vs 97.86 ml, P=0.02), duration of first detrusor contraction (-41.54 vs -18.65 s, P=0.03) and the number of patients with detrusor contraction (-20 vs -9, P=0.02). In both the groups, no patients developed VUR. CONCLUSIONS: BTX-A intradetrusor and intratrigonal injections are more effective compared with those excluding the trigone for patients with NDO with incontinence. Intratrigonal injections do not induce VUR.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Fármacos Neuromusculares/uso terapêutico , Bexiga Urinária Hiperativa/tratamento farmacológico , Incontinência Urinária/tratamento farmacológico , Feminino , Humanos , Masculino , Estudos Prospectivos , Qualidade de Vida/psicologia , Método Simples-Cego , Traumatismos da Medula Espinal/complicações , Resultado do Tratamento , Bexiga Urinária Hiperativa/etiologia , Incontinência Urinária/etiologia , Refluxo Vesicoureteral/tratamento farmacológico
17.
Adv Chronic Kidney Dis ; 22(4): 325-30, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26088078

RESUMO

The role of antimicrobial prophylaxis for the prevention of recurrent urinary tract infections in children with vesicoureteral reflux that was identified following a urinary tract infection has been the source of considerable debate. Prior studies had failed to show a benefit in the prevention of recurrent infection. The National Institutes of Health funded the Randomized Intervention for Vesicoureteral Reflux (RIVUR) study to determine if there was a benefit to the use of prophylaxis. Results of the RIVUR study indicated that there was a 50% reduction in the risk of recurrent urinary tract infection in those children on the prophylaxis arm. Adverse events with the use of prophylaxis were noted to be few. Renal scarring was noted in only a small number of children at study entry and no reduction in scarring was noted between the placebo and the treated groups. The impact of the RIVUR study on the current evaluation and management of children with urinary tract infections and vesicoureteral reflux is detailed.


Assuntos
Antibacterianos/uso terapêutico , Cicatriz/prevenção & controle , Nefropatias/prevenção & controle , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Infecções Urinárias/prevenção & controle , Refluxo Vesicoureteral/tratamento farmacológico , Pré-Escolar , Humanos , Lactente , Recidiva , Infecções Urinárias/etiologia , Refluxo Vesicoureteral/complicações
18.
Indian J Med Res ; 141(4): 473-7, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26112850

RESUMO

BACKGROUND & OBJECTIVES: This cross-sectional study was conducted at a tertiary care centre in Puducherry, south India, with the aim of finding the profile of the paediatric urinary tract infection (UTI), bacterial pathogens involved, and also to observe vesicoureteric reflux (VUR) and renal scarring in these patients. METHODS: A total of 524 paediatric patients ≤13 yr, suspected to have UTI, were included in the study. Urine samples were collected, processed for uropathogen isolation and antibiotic susceptibility test was performed as per the Clinical and Laboratory Standards Institute (CLSI) guidelines. Thirty two culture proven children with UTI underwent micturating cysto-urethrography (MCU) and dimercaptosuccinic acid (DMSA) scanning was done for 69 children. RESULTS: o0 f the 524 children, 186 (35.4%) had culture proven UTI with 105 (56.4%) being infants, 50 (27.4%) between 1-5 yr, 30 (16.12%) between 5-13 yr and 129 (69.35%) males. Posterior urethral valve (PUV) was noted in three, hydronephrosis in one, VUR in 18 and renal scarring in 33. VUR as well as renal scarring were more in males >1 yr of age. A significant association (P=0.0054) was noted with a combined sensitivity and specificity of these investigations being 83 and 90 per cent, respectively of the MCU and DMSA scans for detecting VUR. Escherichia coli was the most common pathogen isolated, sensitive to nitrofurantoin, followed by cefoperazone-sulbactam, aminoglycosides and meropenem. INTERPRETATION & CONCLUSIONS: Our results indicate that UTI varies with age and gender and extensive evaluation is required in boys over one year of age with UTI. This study also highlights the better efficacy of aminoglycosides, cefoperazone-sulbactam and nitrofurantoin in vitro compared with meropenem in Gram-negative uropathogens.


Assuntos
Escherichia coli/patogenicidade , Infecções Urinárias/microbiologia , Refluxo Vesicoureteral/microbiologia , Aminoglicosídeos/administração & dosagem , Cefoperazona/administração & dosagem , Criança , Pré-Escolar , Escherichia coli/isolamento & purificação , Feminino , Humanos , Índia , Lactente , Recém-Nascido , Masculino , Meropeném , Nitrofurantoína/administração & dosagem , Tienamicinas/administração & dosagem , Infecções Urinárias/tratamento farmacológico , Refluxo Vesicoureteral/tratamento farmacológico
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