Pyelonephritis

[Primary vesicoureteral reflux treatment in childhood: comparsion of two systematic review]

Many medical practices are being carried out unawares of their efficiency, or of their actual impact on the health of the patients, therefore it is necessary to consider the support of professional recommendations with scientific evidence.

THE PRIMARY OBJECTIVE

To perform a systematic review (SR) of the therapeutic management of primary VUR in pediatric urology.

MATERIAL AND METHODS

A systematic review has been performed, including scientific evidence-based medicine criteria, of the articles published in all of the available databases. Inclusion criteria concerning basic quality of the articles were considered essential, as well as exclusion criteria to be able to reject the articles.

RESULTS AND DISCUSSION

Subsequently, and following the critic reading of greater than 320 articles, statistical study of the grouped data was performed according to the type of treatment and to the benefits contributed by each treatment, and also to their undesirable effects. Finally we have made a comparison between our results and recent Cochrane Systematic Review. The following Conclusions were drawn from the results obtained and from the analysis of the texts. Both medical and surgical treatment present with similar effectiveness concerning resolution of grades I, II and III of VUR, and the former one is the recommended initial treatment following diagnosis. Endoscopic treatment is exactly as effective as open surgery for grades I, II and III with fewer undesirable effects secondary. There are no differences concerning the efficacy of the different injected substances. Not enough evidences exist for degrees IV and V that may recommend or advise against any of the treatments. In any degree of VUR, open surgical treatment is superior as far as medical treatment is concerned only regarding the number of acute pyelonephritis episodes during followup. This conclusion cannot be applied on endoscopic treatment.

Complications of pregnancy in women after childhood reimplantation for vesicoureteral reflux: an update with 25 years of followup

Surgery for the correction of vesicoureteral reflux has been performed routinely since the early 1960s. In 1986 a large group of women who underwent childhood ureteral reimplantation surgery was contacted and surveyed concerning infections, pregnancies and other complications. A notably high rate of cystitis and pyelonephritis was found during pregnancy. Because 9 years have passed and many more pregnancies have occurred, we contacted this cohort again as well as a new cohort of historical controls to reassess long-term complications of childhood ureteral reimplantation in children. Of 67 women who underwent reimplantation with an average followup of 25 years 62 were contacted of whom 75% had urinary tract infections after becoming sexually active and 65% had urinary tract infections with pregnancies. Of 141 pregnancies 57 (40%) were complicated by urinary tract infections and 21 (15%) terminated in spontaneous abortion. Of 37 women with primary vesicoureteral reflux and no surgery with an average followup of 25.5 years there was a 15% prevalence of urinary tract infections with pregnancy in 21. Of 75 pregnancies in this group 14 (18%) terminated in spontaneous abortion. Women with urinary tract infections and reflux as children have high rates of cystitis with the onset of sexual activity whether or not they underwent reimplantation as children. Those who underwent reimplantation as children are at significant risk of urinary tract infection in pregnancy but not at a higher risk of miscarriage than the general population. Education, screening and antibiotic prophylaxis during pregnancy should be considered.

Management of urinary tract infections in pregnancy: a review with comments on single dose therapy

Most investigators agree that the adverse effects of urinary tract infections in pregnancy can be abrogated by effective early detection and treatment. However, the optimal methods for screening and treatment remain controversial. Although single-dose therapy has not been applied to pregnant women with acute pyelonephritis, most but not all studies which have compared single-dose with longer courses of beta-lactam or other antibiotics in pregnant asymptomatic bacteriuric women have shown no differences in outcome. This paper reviews recent trials of single-dose treatment of bacteriuria in pregnant women.