Revisiting the EAU Paediatric Urology Guideline Risk Grouping On Vesicoureteral Reflux: Shall We Challenge Ourselves?

  • İyimser Üre Osmangazi University Faculty of Medicine, Department of Urology
  • Serhat Gürocak Gazi University Faculty of Medicine, Department of Urology
  • Özgür Tan Gazi University Faculty of Medicine, Department of Urology
  • Cenk Acar özel eryaman hastanesi, Ankara
  • İrfan Atay Gazi University Faculty of Medicine, Department of Urology
  • Esat Ak Gazi University Faculty of Medicine, Department of Urology
  • Zafer Sınık Pamukkale University Faculty of Medicine, Department of Urology
Keywords: Vesicoureteral reflux, treatment, risk


Objective: To challenge retrospectively the treatment outcomes of vesicoureteral reflux (VUR) management according to new EAU Paediatric Urology Guideline Risk Grouping on VUR.Methods: The records of the patients who received medical and/or surgical treatment between 2009-2012 due to VUR were reviewed. History, demographic variables, diagnostic features (presence of renal scar, grade of reflux, laterality), clinical course, causes of failure, secondary intervention type and follow-up variables were analyzed. The patients were classified as low, moderate and high-risk groups according to EAU paediatric urology guideline. Treatment failure is defined as new urinary tract infection and presence of new renal scar during follow-up.Results: A total of 157 patients with 232 renal units (RU) were treated due to VUR. 33(71.7%) of 46RU’s were treated with sub-ureteric injection and 18(39.1%) unsuccessful RU’s were treated with re-injection in low risk group. Only 2(11.1%) re-injected RU’s had postoperative UTI and/or new renal scar at follow-up. In moderate risk group, 54 and 7 of 61 unsuccessful RU’s were treated with re-injection and ureteral re-implantation, respectively. 4(7.4%) of 54 had postoperative UTI and/or new renal scar at follow-up. In high-risk group, 13 and 12 of 25 unsuccessful RU’s treated with re-injection and ureteral re-implantation, respectively.Conclusion: We detected over treatment in low risk group. Success of the surgical correction was evident in moderate and high-risk group. The surgeon should be more pursuer in low risk and more invasive in moderate and high-risk group.


Tekgül S, Riedmiller H, Hoebeke P, Kočvara R, Nijman RJM, Radmayr C, et al. EAU guidelines on vesicoureteral reflux in children. Eur Urol. 2012;62:534–42.

Jayanthi V, Patel A. Vesicoscopic ureteral reimplantation: a minimally invasive technique for the definitive repair of vesicoureteral reflux. Adv Urol. 2008;973616.

Lebowitz RL, Olbing H, Parkkulainen KV, Smellie JM, Tamminen-Möbius TE. International system of radiographic grading of vesicoureteric reflux. International Reflux Study in Children. Pediatr Radiol. 1985;15:105–9.

O’Donnell B, Puri P. Treatment of vesicoureteric reflux by endoscopic injection of Teflon. Br Med J Clin Res Ed. 1984;289:7–9.

Läckgren G, Wåhlin N, Stenberg A. Endoscopic treatment of children with vesico-ureteric reflux. Acta Paediatr Oslo Nor 1992 Suppl. 1999;88:62–71.

Cohen SJ. The Cohen reimplantation technique. Birth Defects Orig Artic Ser. 1977;13:391–5.

Peters CA, Skoog SJ, Arant BS, Copp HL, Elder JS, Hudson RG, et al. Summary of the AUA Guideline on Management of Primary Vesicoureteral Reflux in Children. J Urol. 2010;184:1134–44.

Nickel JC. Management of urinary tract infections: historical perspective and current strategies: Part 1--Before antibiotics. J Urol. 2005;173:21–6.

Edwards D, Normand IC, Prescod N, Smellie JM. Disappearance of vesicoureteric reflux during long-term prophylaxis of urinary tract infection in children. Br Med J. 1977;2:285–8.

Garin EH, Olavarria F, Garcia Nieto V, Valenciano B, Campos A, Young L. Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study. Pediatrics. 2006;117:626–32.

Pennesi M, Travan L, Peratoner L, Bordugo A, Cattaneo A, Ronfani L, et al. Is antibiotic prophylaxis in children with vesicoureteral reflux effective in preventing pyelonephritis and renal scars? A randomized, controlled trial. Pediatrics. 2008;121:e1489–1494.

Coleman R. Early management and long-term outcomes in primary vesico-ureteric reflux. BJU Int. 2011;108 Suppl 2:3–8.

Mathews R, Carpenter M, Chesney R, Hoberman A, Keren R, Mattoo T, et al. Controversies in the management of vesicoureteral reflux: the rationale for the RIVUR study. J Pediatr Urol. 2009;5:336–41.

Holmdahl G, Brandström P, Läckgren G, Sillén U, Stokland E, Jodal U, et al. The Swedish reflux trial in children: II. Vesicoureteral reflux outcome. J Urol. 2010;184:280–5.

Elder JS, Peters CA, Arant BS, Ewalt DH, Hawtrey CE, Hurwitz RS, et al. Pediatric Vesicoureteral Reflux Guidelines Panel summary report on the management of primary vesicoureteral reflux in children. J Urol. 1997;157:1846–51.

Kaye JD, Srinivasan AK, Delaney C, Cerwinka WH, Elmore JM, Scherz HC, et al. Clinical and radiographic results of endoscopic injection for vesicoureteral reflux: defining measures of success. J Pediatr Urol. 2012;8:297–303.

Puri P, Mohanan N, Menezes M, Colhoun E. Endoscopic treatment of moderate and high grade vesicoureteral reflux in infants using dextranomer/hyaluronic acid. J Urol. 2007;178(4 Pt 2):1714–1716; discussion 1717.

Puri P, Kutasy B, Colhoun E, Hunziker M. Single center experience with endoscopic subureteral dextranomer/hyaluronic acid injection as first line treatment in 1,551 children with intermediate and high grade vesicoureteral reflux. J Urol. 2012;188(4 Suppl):1485–9.

Original Research