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

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.