title: Persistence and recurrence of vesicoureteric reflux in children after endoscopic therapy - implications of a risk-adapted follow-up.
abstract: BACKGROUND
  There is no well-defined follow-up scheme available to reliably detect persistent or recurrent vesicoureteric reflux (VUR) after endoscopic therapy (ET), but also to reduce postoperative invasive diagnostics in these children. Our aim was the evaluation of possible predictors of persistence and recurrence of VUR, in order to elaborate and test a risk-adapted follow-up regimen.
  
  
  METHODS
  92 patients (85/92%f, 7/8%m, age 2.99y) underwent direct isotope cystography (DIC) three months after ET. Persistent or recurrent VUR, scarring on dimercaptosuccinic acid (DMSA) scans and further fUTIs after therapy (follow-up 24.6 m) were documented and analysed.
  
  
  RESULTS
  VUR persistence 3 months after ET was found in 11 (11.9%) patients; recurrent VUR in 4 (4.3%) patients. Scarring on preoperative DMSA and dilating VUR (°III and °IV) were significantly associated with recurrent VUR. If only children with preoperative positive DMSA scan or dilating VUR would have undergone DIC, only 58/92 DICs (64%) would have been necessary. Only 45.5% of otherwise detected VURs would have been identified using this risk-adapted strategy.
  
  
  CONCLUSIONS
  Limiting invasive follow-up diagnostics (VCUG) and, therewith, the radiation burden in a predefined group of patients at risk for persistence or recurrence of VUR is not recommended, due to the significant chance of missing persistent or new onset contralateral VUR. Therefore, we recommend a routine follow-up VCUG after ET. Further prospective scientific efforts to evaluate new, alternative factors influencing persistence and recurrence of VUR, in order to establish an effective follow-up strategy, are warranted.
authors.affiliation: Department of Pediatric Urology, Hospital of the Sisters of Charity, Linz, Austria.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Haid
authors.affiliation: Department of Pediatric Urology, Hospital of the Sisters of Charity, Linz, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Berger
authors.affiliation: Department of Pediatric Urology, Hospital of the Sisters of Charity, Linz, Austria.
authors.forename: Judith
authors.initials: J
authors.lastname: Roesch
authors.affiliation: Department of Pediatric Urology, Hospital of the Sisters of Charity, Linz, Austria.
authors.forename: Tanja
authors.initials: T
authors.lastname: Becker
authors.affiliation: Department of Pediatric Urology, Hospital of the Sisters of Charity, Linz, Austria.
authors.forename: Mark
authors.initials: M
authors.lastname: Koen
authors.affiliation: Department of Nuclear Medicine, Hospital of the Sisters of Charity, Linz, Austria.
authors.forename: Werner
authors.initials: W
authors.lastname: Langsteger
authors.affiliation: Department of Pediatric Urology, Hospital of the Sisters of Charity, Linz, Austria.
authors.forename: Josef
authors.initials: J
authors.lastname: Oswald
keywords: direct isotope cystography; endoscopic reflux therapy; follow-up; pediatric urology; vesicoureteric reflux