Febrile Urinary Tract Infections in Children With an Early Negative Voiding Cystourethrogram After Treatment of Vesicoureteral Reflux With Dextranomer/Hyaluronic Acid

Purpose

Children in whom nonsurgical management for vesicoureteral reflux fails are considered candidates for surgical intervention. An option is endoscopic treatment with Deflux®. We reviewed our experience with febrile urinary tract infections in children following initial successful treatment of vesicoureteral reflux with Deflux and identified factors predictive of post-Deflux urinary tract infections. We also analyzed the incidence of delayed vesicoureteral reflux recurrence in these patients.

Materials and Methods

We performed a retrospective chart review of all children from 2002 to 2006 diagnosed with grades I to IV vesicoureteral reflux who were treated with Deflux and who had a negative initial followup voiding cystourethrogram at 2 to 5 months. Patients were categorized into post-Deflux infection and infection-free groups. Predictive factors, including the number of preoperative febrile urinary tract infections, dysfunctional elimination and renal cortical defects on dimercapto-succinic acid scan, were analyzed and compared.

Results

Of the patients 45 met all study inclusion and exclusion criteria. A total of 12 patients (27%) who were diagnosed with a culture documented febrile urinary tract infection were categorized into the infection group. Of 12 children in the post-Deflux infection group 11 (92%) had multiple predictors compared to 14 of 33 (42%) who remained infection-free (p = 0.005). Ten of these 12 patients (92%) were found to have evidence of vesicoureteral reflux when evaluated with voiding cystourethrogram/radionuclide cystogram after infection.

Conclusions

This study demonstrates that up to 27% of patients treated endoscopically may have a febrile urinary tract infection after an initial negative postoperative voiding cystourethrogram/radionuclide cystogram at 2 to 5 months and up to 92% of those will demonstrate delayed vesicoureteral reflux recurrence. Children with a history of 2 or more predictive factors, including multiple febrile urinary tract infections, dysfunctional elimination and/or renal cortical defects on dimercapto-succinic acid scan, may not be optimal candidates for Deflux. If endoscopic treatment is chosen, these patients require more vigilant followup, including late voiding cystourethrogram.

Key Words: kidney, ureter, urinary tract infections, vesico-ureteral reflux, deflux

Abbreviations and Acronyms: DMSA, dimercapto-succinic acid, RNC, radionuclide cystogram, UTI, urinary tract infection, VCUG, voiding cystourethrogram, VUR, vesicoureteral reflux