[The role of endoscopy in the diagnosis and therapeutic orientation of vesico-ureteral-reflux (VUR) in the child. 280 cases (author's transl)].
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Adolescent↗
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[Surgical treatment of vesico-ureteral reflux (VUR) in double ureter].
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Child↗
Vesicoureteral reflux and anorectal malformations.
BACKGROUND: Renal and urinary tract anomalies are frequently associated with anorectal malformations (ARMs) and may adversely affect long-term renal outcomes, if not detected early. However, reliable clinical predictors for significant urologic abnormalities across different ARM phenotypes remain poorly defined. OBJECTIVE: To determine the prevalence and grade distribution of vesicoureteric reflux (VUR) in neonates with ARMs, and to explore its association with renal and urinary tract anomalies, the complexity of the ARM phenotype, and other factors are associated with high-grade VUR. METHODS: In this retrospective cross-sectional study, medical records of 64 neonates diagnosed with ARMs and managed at a tertiary children's hospital between 2018 and 2025 were reviewed. All patients underwent renal and urinary tract ultrasonography. Voiding cystourethrography (VCUG) was performed for all neonates according to our institutional protocol, regardless of ultrasound findings or ARM phenotype. Demographic characteristics, ARM phenotype (less-complex vs. complex), urologic findings, urinary tract infection (UTI) history, and associated anomalies were analyzed. Multivariable logistic regression models were used to identify independent predictors of complex ARM phenotype and high-grade VUR. RESULTS: The cohort consisted of 64 neonates (75% male) with a mean gestational age of 37.36 ± 1.83 weeks and a mean birth weight of 2940 ± 601 g. Renal and urinary tract anomalies were common, with hydronephrosis observed in 48.4%, VUR of any grade in 39.1% and hydroureter in 35.9%,of patients. High-grade VUR was identified in 21.9% of patients, and a documented history of UTI was present in 18.8% of the entire cohort. In multivariable analyses, birth weight, presence of VUR, and UTI history were not independently associated with complex ARM phenotype. Additionally, no demographic or clinical variables reliably predicted high-grade VUR. The predictive performance of the regression model for high-grade VUR was limited (AUC = 0.60). CONCLUSION: Renal and urinary tract anomalies are highly prevalent among neonates with ARMs, with VUR representing a prominent finding. The lack of robust clinical predictors for complex ARM phenotype or high-grade VUR underscores the limitations of selective screening strategies and supports the role of comprehensive urologic evaluation in neonates with ARM, regardless of anatomic subtype.
Humans↗
Exploring precision risk in pediatric vesicoureteral reflux: Innate immune gene variations and reflux outcomes in the RIVUR cohort.
INTRODUCTION: Children with vesicoureteral reflux (VUR) are at increased risk for morbidity from recurrent urinary tract infections (UTIs), yet the factors influencing spontaneous VUR resolution remain poorly defined. This study evaluates whether genetic variations in key urinary innate immune effectors (DEFA1A3, DMBT1, and RNASE7) influences VUR resolution and interacts with prophylaxis to alter clinical response. METHODS: We conducted a secondary analysis of 303 RIVUR participants with available DEFA1A3 and DMBT1 copy number variation (CNV) data and RNASE7 rs1263872 genotype. Primary outcomes were (1) VUR improvement (decrease in grade) and (2) VUR resolution at study exit. Multivariable logistic regression models included genotype, treatment, and their interactions, adjusting for age, sex, baseline grade (high vs low), laterality, bowel/bladder dysfunction, and any UTI. Internal validation used 2000-sample bootstrap with bias-corrected and accelerated confidence intervals and influence diagnostics. RESULTS: Clinical covariates did not significantly predict VUR improvement. Children with DEFA1A3 CNV >5 had higher odds of improvement (OR 2.36, 95% CI 1.12-4.96, p = 0.023), an effect that remained significant in bootstrap analyses. High-grade VUR was associated with lower odds of resolution (OR 0.34, 95% CI 0.12-0.94, p = 0.038). A significant interaction was observed between prophylaxis and high DMBT1 copy number for VUR resolution (interaction OR 2.99, 95% CI 1.11-8.04, p = 0.031); no interaction was seen for improvement. RNASE7 rs1263872 was not associated with either outcome. CONCLUSION: Innate immune gene variation may contribute to heterogeneity in VUR outcomes. High DEFA1A3 copy number was associated with reflux improvement and a DMBT1-prophylaxis interaction was associated with reflux resolution. The results of this study is hypothesis-generating and prompt further evaluation to assess whether a subset of children may experience structural benefit from prophylaxis or have a more favorable natural history based on their innate immune genotype.
Humans↗
The future of pediatric vesicoureteral reflux management.
BACKGROUND AND OBJECTIVE: Vesicoureteral reflux (VUR) is a common condition in pediatric urology, yet important uncertainties persist regarding risk stratification, imaging strategies, and prevention of long-term renal damage. Emerging technologies may help address these challenges. This review provides a forward-looking overview of recent advances in artificial intelligence (AI) and immunomodulation that may influence future management of pediatric VUR. METHODS: A forward-looking literature review was performed using the PubMed database (January 2000-March 2025), focusing on studies addressing AI, immunomodulation, or vaccination in the context of VUR and urinary tract infections. Criteria of inclusion were the relevance to pediatric VUR, the novelty of the proposed concept, the potential clinical implications and, for the AI literature, the existence of a clinical evaluation of the algorithm on a dataset from patients. KEY FINDINGS AND LIMITATIONS: AI-based models show promising performance in supporting clinical decision-making, including prediction of the need for voiding cystourethrography, automated grading of VUR, estimation of recurrent urinary tract infection risk and prediction of chemoprophylaxis. These tools may facilitate more individualized diagnostic and therapeutic strategies, although current evidence is largely retrospective and requires prospective validation. Immunization and immunomodulatory approaches aim to reduce infection burden and modulate inflammatory pathways associated with renal scarring. While early experimental and adult clinical data are encouraging, pediatric-specific evidence remains limited, and clinical applicability in children with VUR is not yet established. CONCLUSION: Artificial intelligence and immunologically targeted strategies represent complementary, emerging approaches that may contribute to more personalized management of pediatric VUR. At present, both should be regarded as exploratory tools whose clinical impact will depend on further validation and appropriately designed pediatric studies.
Humans↗
Effect of vesicoureteral reflux on renal function in children with recurrent urinary tract infection.s.
The functional damage caused by vesicoureteral reflux (VUR) has been examined by unilateral clearance studies in 22 children with recurrent urinary tract infection (UTI) and representing 23 kidneys with large VUR. 7 kidneys with small to moderate VUR and 14 kidneys without VUR. Inulin clearance, Na+ excretion and glucose reabsorption were determined. In kidneys without or with small and moderate VUR, UTI had no effect on renal function if treated. In kidneys with large VUR extending into the pelvis and dilating the ureter, there was a gradual deterioration of glomerular filtration rate (GFR) that was accelerated after the age of 6 yr. Before puberty more than 50% of renal function was lost despite strict medical care of the UTI. If this functional loss was unilateral, hyperfunction of the contralateral kidney was generally observed. Maximal glucose reabsorption was depressed in proportion to GFR. In kidneys with unilaterally low GFR, the fractional Na+ excretion was consistently increased as compared to the contralateral kidney with normal GFR. This adaptive increase in Na+ excretion must therefore be of intrarenal origin.
Adolescent↗
Urobiota analysis and genome-wide association study in pediatric recurrent urinary tract infections and vesicoureteral reflux.
Urinary tract infections (UTIs) are the most common severe bacterial infections in young children, often associated with vesicoureteral reflux (VUR). To explore host genetic-microbiota interactions and their clinical implications, we analyzed the urinary microbiota (urobiota) and conducted genome-wide association studies for bacterial abundance traits in pediatric patients with UTI and VUR from the Randomized Intervention for Children with Vesicoureteral Reflux and Careful Urinary Tract Infection Evaluation cohorts. We identified 4 urobiota community types based on relative abundance, characterized by the genera Enterococcus, Prevotella, Pseudomonas, and Escherichia/Shigella, and their associations with VUR, age, and toilet training. Children with VUR exhibited decreased microbial diversity and increased abundance of genera that included opportunistic pathogens, suggesting a disrupted urobiota. We detected genome-wide significant genetic associations with urinary bacterial relative abundances, in or near candidate genes including CXCL12, ABCC1, and ROBO1, which are implicated in urinary tract development and response to infection. We showed that Cxcl12 was induced 12 hours after uropathogenic bacterial infection in mouse bladder. The association with CXCL12 suggests a genetic link between UTI, VUR, and cardiovascular phenotypes later in life. These findings provide the first characterization to our knowledge of host genetic influences on the pediatric urobiota in UTI and VUR, offering insights into the interplay between disease, host genetics, and the urobiota composition.
Urinary Tract Infections↗
Detection of vesicoureteric reflux using radionuclide micturating cystography.
Radionuclide micturating cystography (RMC) has been compared with the standard micturating cystourethrogram for detecting vesicoureteric reflux (VUR). Of 16 renal tracts with VUR radiologically classified as gross all had reflux demonstrated on RMC and in 15 of these the reflux reached the renal pelvis. Eight of the 12 renal tracts with moderate VUR and three of four with slight VUR were shown to reflux on RMC. RMC should prove valuable for following the course of patients with VUR treated surgically or conservatively because of the lower gonadal radiation dose resulting from this technique compared with the conventional radiological method.
Adolescent↗
The growth of the kidneys in children with vesicoureteric reflux.
In a retrospective study, 69 kidneys with VUR were divided into 2 groups: One group (A) where VUR stopped within 1 year after operation or conservative treatment and a second group (B) where VUR continued for more than 1 year. Group A had somewhat more severe grades of reflux than group B. The number of infections were practically the same in the two groups. The length of the kidneys was measured at the time of diagnosis and compared with the length at the most recent urography after VUR stopped (group A) on average 2 years and 3 months later and with the most recent urography while VUR was still present (group B) on average 1 year and 9 months later. It was found that 85% in group A had increased in absolute length while the figure was 60% in group B. If the relative growth is calculated (the kidneys' length in relationship to L1-L3 distance), 60% in group B had decreased while only 30% in group A had decreased.
Child↗
Diagnosis of gross vesico-ureteric reflux using ultrasonography.
A simple non-invasive ultrasonic technique which identifies gross vesico-ureteric reflux (VUR) in adults is described. It is based on the time position (TP)-mode (or M-mode) of ultrasound imaging. This method warrants assessment as a possible screening procedure for gross VUR in newborn children.
Dilatation, Pathologic↗
[Urinary tract infection and vesicoureteral reflux in childhood (author's transl)].
In all recurrent urinary tract infections and fever attacks of unknown origin in children one should consider the possibility of the presence of an vesicoureteral reflux (VUR) and suitable examinations should be carried out. A further indication of the possible presence of a childish reflux is manifest when enuresis occurs beyond the normal age for this phenomenon. In order to determine whether or not a reflux is present an ad hoc examinational procedure is necessary. There is a definite indication that a VUR operation is called for in cases of pronounced grades of reflux with a corresponding change in the ostia, in the case of marked pyelonephritic changes which are roentgenologically demonstrable and after a conservative treatment of six months.
Child↗
Hot vs cold knife for endoscopic ablation of posterior urethral valves: a systematic review by the EAU-YAU paediatric urology working group.
INTRODUCTION: Posterior urethral valves (PUV) are the most frequent cause of congenital lower urinary tract obstruction in males. Despite early surgical ablation, up to 22% of patients develop chronic kidney disease and 11% progress to end-stage renal disease. Multiple endoscopic modalities have been described for valve ablation but the optimal technique remains uncertain. This systematic review aims to determine whether cold or hot knife ablation provides superior effectiveness for primary endoscopic treatment of PUV in a single surgical session. MATERIAL AND METHODS: A systematic search of PubMed and Embase databases was conducted to identify studies comparing cold and hot knife techniques for endoscopic ablation of PUV in children, covering all publications up to December 2025. The review was performed in accordance with PRISMA 2020 guidelines and was prospectively registered in PROSPERO (ID CRD420251180556). Original studies including patients <18 years who underwent primary valve ablation with postoperative cystoscopy or VCUG and ≥6 months of follow-up were included. Quality assessment was done using RoB 2.0 for randomized trials and MINORS for observational studies. RESULTS: A total of 1581 studies were identified, of which 26 met the inclusion criteria, comprising one randomized controlled trial, five prospective, and 20 retrospective studies constituting a sum of 1725 paediatric patients. The overall methodological quality of included studies was moderate, with marked heterogeneity in design, follow-up duration, and outcome reporting, limiting direct comparisons across series. Thus statistical analysis was not possible. Of these, 829 (48.1%) underwent cold valve ablation and 896 (51.9%) underwent hot ablation techniques. Within the cold group, most patients were treated with a cold knife (80.2%), followed by balloon dilatation (7%), the Mohan valvotome (6.5%), cold hook (5%), and, rarely, a modified venous valvulotome (1.3%). Among hot techniques, 32.8% of procedures were performed by electro-fulguration with a resectoscope, 29.4% using a Bugbee electrode, 23.8% with a hook electrode and 14% with laser-based systems. Follow-up ranged from 6 months to 22 years across studies. Single-session success rates for valve ablation ranged from 22% to 100% in the cold resection group and from 71.4% to 100% in the hot resection group. Reintervention for residual valves was reported in 0%-78% of cold cases and in 0%-28.6% of hot resections. Urethral stricture rates ranged from 0% to 11.1% after cold incision and from 0% to 23.8% after hot techniques. Reporting of postoperative outcomes such as urinary tract infection, incontinence, bladder dysfunction, vesicoureteral reflux (VUR) resolution, hydronephrosis improvement, and renal function varied widely among studies and was assessed using different methodologies. CONCLUSIONS: Both cold and hot ablation techniques for PUV achieved high single-session success rates and low complication rates. Cold resection appeared slightly safer, although this finding should be interpreted cautiously given the heterogeneity and observational nature of the available data.
Humans↗
[Kidney damage in sterile reflux].
On the basis of the data mentioned and taking into consideration the fact that the whole complex of problems is not yet clarified unequivocally we come to the following conclusions: 1. Up to now there are no proofs for the fact that the most frequent type of reflux, i.e. the simple reflux of the urine from the urinary bladder into the upper urinary passage causes a renal damage. 2. The complicated VUR may certainly cause a urinary stasis kidney. In simultaneous calyco-tubular reflux probably focal shrinkings of the parenchyma may develop.
Age Factors↗