Incidence and Risk Factors of Urinary Tract Infection after Endoscopic Therapy for Vesicoureteral Reflux in Children

Ja Yoon Ku; Bu Kyung Park; Sang Don Lee

doi:10.14777/kjutii.2014.9.1.34

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

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

Original Article

Korean J Urogenit Tract Infect Inflamm 2014;9(1):34-38.

Published online: 17 April 2014

DOI: https://doi.org/10.14777/kjutii.2014.9.1.34

Incidence and Risk Factors of Urinary Tract Infection after Endoscopic Therapy for Vesicoureteral Reflux in Children

Ja Yoon Ku^1,^∗, Bu Kyung Park^2,^∗, Sang Don Lee^1,^2,

¹Department of Urology, Pusan National University Children Hospital, Yangsan, Korea

²Department of Urology, Pusan National University School of Medicine, Yangsan, Korea

^∗ These authors contributed equally to this study as co-first authors.

Correspondence to: Sang Don Lee Department of Urology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan 626-770, Korea Tel: +82-55-360-2134, Fax: +82-55-360-2931 E-mail: lsd@pusan.ac.kr

Received 31 March 201414 April 2014 Accepted 15 April 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Urinary tract infections, Vesicoureteral-reflux, Endoscopic theraphy

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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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