Aktuelle Entwicklung in Diagnostik und Therapie des vesico-uretero-renalen Refluxes bei Kindern

484 children aged from 14 days to 16 years suspected of suffering from vesico ureteral reflux (VUR) were investigated with voiding cystourethrography (VCUG), ultrasonography, voiding ultrasonography with air contrast, samples of urin and blood and clinically. Al important clinical, blood and urin parameters were assessed from pediatritions in private practice and from the childrens urologic outpatient department. The children underwent an examination to show existing urinary tract infection (UTI). 160 children show a VUR. In 993 reno-ureteral units the VCUG showed 197 refluxive units while the ultrasonic reflux testing with air presented 154 refluxive units. Reviewing the international literature, VCUG obviously does not have a sensitivity of 100%. 22 children show VUR only in the ultrasonic examination but not in the VCUG which is seen as the gold standard examination. Other studies show that about 4-5% of the refluxive ureters were only found by ultrasonic examinations but not by the VCUG. To show the relationship between UTI and VUR in children a score from the literature was used to proof whether the children have UTI, especially pyelonephritis. 57,8% (64 patients) of the children with proved pyelonephritis showed an existing VUR. Children with UTI but without proved pyelonephritis showed a VUR in 33,3%. Sonographic malformations are another risk factor for developing VUR. 19,2% of the children showed ultrasonic pathologies of the urinary tract. In 33,9% it was associated with VUR. Especially patients with double sided renal duplication, showed VUR in 100%. These data show that UTI of children always have to lead to invasive radiologic diagnostic of the urinary tract. Only if the VUR is diagnosed and treated early later consequences like hydronephrosis, renal scaring and loss of renal function could be avoided. The treatment of VUR is long term antibiotic prophylaxis or anti reflux surgery. In this study 10 of the children underwent anti reflux surgery, 6 had to be further more treated medically for persisting VUR (almost of the other side). These data confirmed the existing opinion in the literature to use antireflux surgery only restrictive by VUR degreed °III-°IV. These data showed to that there is no standard procedure in diagnostic and treatment of children with UTI for pediatritions in private practice. A standard procedure of diagnostic and treatment oft UTI and VUR in children have to be established