title: Downgrading of high-grade vesicoureteral reflux is a reliable option in the treatment of children with grade IV‒V reflux accompanied by breakthrough infections.
abstract: OBJECTIVE
  To evaluate incidence of urinary tract infection (UTI) and natural history of downgraded vesicoureteral reflux (VUR) in children with high-grade VUR following endoscopic correction.
  
  
  METHODS
  We retrospectively studied 54 children (13 males and 41 females) with a mean age of 1.8 years who underwent endoscopic correction of Grade IV‒V VUR due to breakthrough infections while on antibiotic prophylaxis. Reflux was Grade IV in 40 (74%) and V in 14 (26%) patients comprising 95 renal refluxing units (RRU). Reflux was corrected in 72 (76%) RRU. 18 (34%) patients/23 (24%) RRU demonstrated downgrading of VUR. 21 of the 23 RRU showed Grade II and 2 Grade III VUR, and were taken off antibiotic prophylaxis and allocated to observation. Patients were followed for 2-22 years (median 14 years).
  
  
  RESULTS
  Technetium 99m dimercaptosuccinic acid renal scan demonstrated preoperative renal scarring in 21 (78%) of the 23 RRU with downgraded VUR. None of the children developed febrile UTI after surgery. 1 RRU showed renal function deterioration. 8 (44%) of the 18 patients underwent follow-up voiding cystourethrogram, and in 7 (88%) there was either spontaneous resolution of VUR or downgrade to Grade I VUR.
  
  
  CONCLUSIONS
  Downgrading of VUR is a reasonable option in patients with high-grade VUR suffering from breakthrough infections while on antibiotic prophylaxis. It leads to the cessation of febrile UTIs, further spontaneous resolution of VUR and may potentially avoid renal damage.
authors.affiliation: Department of Pediatric Urology, Shaare Zedek Medical Center, Faculty of Medical Science, Hebrew University, Jerusalem, Israel.
authors.forename: Stanislav
authors.initials: S
authors.lastname: Kocherov
authors.forename: Wael Abu
authors.initials: WA
authors.lastname: Arafeh
authors.forename: Alexander
authors.initials: A
authors.lastname: Zeldin
authors.forename: Israel A
authors.initials: IA
authors.lastname: Ostrovsky
authors.forename: Alexander
authors.initials: A
authors.lastname: Ioscovich
authors.forename: Amicur
authors.initials: A
authors.lastname: Farkas
authors.forename: Boris
authors.initials: B
authors.lastname: Chertin
mesh_terms: D000293:Adolescent; D019072:Antibiotic Prophylaxis / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000517:prevention & control; D011704:Pyelonephritis / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D018666:Ureteroscopy / Q000009:adverse effects*; D014718:Vesico-Ureteral Reflux / Q000453:epidemiology / Q000601:surgery*; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid