Journal List > Korean J Urogenit Tract Infect Inflamm > v.9(1) > 1059946

Ku, Park, and Lee: Incidence and Risk Factors of Urinary Tract Infection after Endoscopic Therapy for Vesicoureteral Reflux in Children

Abstract

Purpose

The purpose of this study is to evaluate the incidence and risk factors of febrile urinary tract infection (UTI) after endoscopic therapy for vesicoureteral reflux (VUR).

Materials and Methods

Analysis of the clinical data of 88 children (128 refluxing renal units; male 60%, female 40%) in a single institution during March 2011-June 2013 including age, gender, sorts and volume of agent for injection, preoperative VUR grade, recurrent UTI, bladder dysfunction, nephropathy, postoperative VUR, urinalysis, and urine culture results was performed retrospectively. All patients were followed for three to 62 months (average 25 months).

Results

After the first injection, the complete resolutions rate of VUR (by ureter) was 72.7%, consisting of grade I 4 (90%), grade II 11 (84.6%), grade III 29 (76.3%), grade IV 33 (66%), and grade V 93 (72.7%) ureters. Preoperative UTI and febrile UTI were present in 81 (92.0%) and 49 patients (55.7%), respectively. Preoperative recurrent UTI and febrile UTI were observed in 53 (60.2%) and 30 patients (34.1%), respectively. Postoperative UTI and febrile UTI occurred in eight (9.1%) and in five patients (5.7%), respectively. In multivariate analysis, only preoperative recurrent UTI (odds ratio [OR], 0.17; p=0.04) and bladder trabeculation (OR, 0.104; p=0.038) were independent variables after endoscopic therapy.

Conclusions

Our data support that the successful endoscopic correction of VUR is associated with a low incidence of febrile UTI. The highest risk factor for post injection UTI is preoperative recurrent UTI and bladder dysfunction. Therefore, patients with preoperative recurrent UTI and bladder dysfunction require careful observation after endoscopic therapy for VUR.

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Table 1.
Preoperative patient demographics
Demographics Patients, n (%)
Overall 88 (100.0)
Gender  
   Female 35 (39.8)
   Male 53 (60.2)
UTI 81 (92.0)
Febrile UTI 49 (55.7)
High grade VUR (IV, V) 57 (64.8)
Renal scarring on preoperative DMSA scan 46 (52.3)
Recurrent UTI 53 (60.2)
Recurrent febrile UTI 30 (34.1)
Types of inject material  
   Deflux 59 (67.0)
   Macroplastique 29 (33.0)
Amount of inject material (ml)  
   <1.5 24 (27.3)
   1.5≤ and <2.5 31 (35.2)
   2.5≤ 33 (37.5)

UTI: urinary tract infection, VUR: vesicoureteral reflux, DMSA: dimercaptosuccinic acid.

Table 2.
The resolution rate of vesicoureteral reflux (VUR)
Refluxing renal VUR grade units (n) Resolution (%) Complete resolution (%)
I5 4 (90) 4 (90)
II 13 11 (84.6) 11 (84.6)
III 38 31 (81.6) 29 (76.3)
IV 50 45 (90) 33 (66)
V22 16 (72.7) 16 (72.7)
Total 128 107 (83.6) 93 (72.7)
Table 3.
Multivariate analysis of risk factors estimating UTI after endoscopic injection
Risk factor OR (95% CI) p-value
Preoperative febrile UTI 4.789 (0.821-27.941) 0.082
Preoperative recurrent UTI 0.173 (0.031-0.954) 0.044
High grade VUR (IV, V) 2.030 (0.395-10.425) 0.396
Renal scarring on preoperative DMSA scan 0.176 (0.028-1.089) 0.062
Bladder trabeculation 0.104 (0.012-0.881) 0.038
Postoperative VUR 0.130 (0.007-2.469) 0.174

UTI: urinary tract infection, OR: odds ratio, CI: confidence interval, VUR: vesicoureteral reflux, DMSA: dimercaptosuccinic acid.

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