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The Changing Concepts of Vesicoureteral Reflux in Children Advances in Urology The Changing Concepts of Vesicoureteral Reflux in Children Guest Editors: Walid A. Farhat and Hiep Nguyen The Changing Concepts of Vesicoureteral Reflux in Children Advances in Urology The Changing Concepts of Vesicoureteral Reflux in Children Guest Editors: Walid A. Farhat and Hiep Nguyen Copyright © 2008 Hindawi Publishing Corporation. All rights reserved. This is a special issue published in volume 2008 of “Advances in Urology.” All articles are open access articles distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Editor-in-Chief Richard A. Santucci, Detroit Medical Center, USA Advisory Editor Markus Hohenfellner, Germany Associate Editors Hassan Abol-Enein, Egypt Walid A. Farhat, Canada David F. Penson, USA Darius J. Bagli, Canada Christopher M. Gonzalez, USA Michael P. Porter, USA Fernando J. Bianco, USA Narmada Gupta, India Jose Rubio Briones, Spain Steven B. Brandes, USA Edward Kim, USA Douglas Scherr, USA Robert E. Brannigan, USA Badrinath Konety, USA Norm D. Smith, USA James Brown, USA Daniel W. Lin, USA Arnulf Stenzl, Germany Peter Clark, USA William Lynch, Australia Flavio Trigo Rocha, Brazil Donna Deng, USA Maxwell V. Meng, USA Willie Underwood, USA Paddy Dewan, Australia Hiep Nguyen, USA Miroslav L. Djordjevic, Serbia Sangtae Park, USA Contents The Changing Concepts of Vesicoureteral Reflux in Children, Walid A. Farhat and Hiep T. Nguyen Volume 2008, Article ID 767138, 1 page Vesicoureteral Reflux: Where Have We Been, Where Are We Now, and Where Are We Going?, Gordon A. McLorie Volume 2008, Article ID 459630, 3 pages Vesicoureteral Reflux, Reflux Nephropathy, and End-Stage Renal Disease,PaulBrakeman Volume 2008, Article ID 508949, 7 pages Bladder Dysfunction and Vesicoureteral Reflux,UllaSillen´ Volume 2008, Article ID 815472, 8 pages Interactions of Constipation, Dysfunctional Elimination Syndrome, and Vesicoureteral Reflux, Sarel Halachmi and Walid A. Farhat Volume 2008, Article ID 828275, 3 pages Vesicoureteral Reflux in the Child with Lazy Bladder Syndrome: The Infrequent Voider, Marco Grasso, Fabrizio Torelli, Salvatore Blanco, Flavio Fortuna, and Marco Baruffi Volume 2008, Article ID 432576, 3 pages Diagnostic Approach to Reflux in 2007, Sumit Dave and Antoine E. Khoury Volume 2008, Article ID 367320, 8 pages Anxiety in Children Undergoing VCUG: Sedation or No Sedation?,DavidW.Herd Volume 2008, Article ID 498614, 12 pages The PIC Cystogram: Its Place in the Treatment Algorithm of Recurrent Febrile UTIs, Jennifer A. Hagerty, Max Maizels, and Earl Y. Cheng Volume 2008, Article ID 763620, 4 pages Radiation Safety and Future Innovative Diagnostic Modalities, Christian Radmayr Volume 2008, Article ID 827106, 3 pages Antibiotic Prophylaxis in the Management of Vesicoureteral Reflux, Marc Cendron Volume 2008, Article ID 825475, 6 pages Antibiotic Prophylaxis for Children with Primary Vesicoureteral Reflux: Where Do We Stand Today?, Michiel Costers, Rita Van Damme-Lombaerts, Elena Levtchenko, and Guy Bogaert Volume 2008, Article ID 217805, 5 pages The Outcome of Surgery versus Medical Management in the Treatment of Vesicoureteral Reflux, Caleb P. Nelson Volume 2008, Article ID 437560, 5 pages Vesicoureteral Reflux and Duplex Systems,JohnC.Thomas Volume 2008, Article ID 651891, 3 pages Treatment of Vesicoureteral Reflux after Puberty, J. Christopher Austin Volume 2008, Article ID 590185, 5 pages Endoscopic Treatment of Vesicoureteral Reflux with Dextranomer/Hyaluronic Acid in Children, Wolfgang H. Cerwinka, Hal C. Scherz, and Andrew J. Kirsch Volume 2008, Article ID 513854, 7 pages AReviewoftheEffect of Injected Dextranomer/Hyaluronic Acid Copolymer Volume on Reflux Correction Following Endoscopic Injection, Sumit Dave and Darius J. Bagli¨ Volume 2008, Article ID 579370, 5 pages Has the Data Efflux Regarding the Promising Outcome Following Injection of Deflux Changed the Management of Adult Vesicoureteral Reflux?,D.E.ZilbermanandY.Mor Volume 2008, Article ID 361324, 5 pages Current Status of Gil-Vernet Trigonoplasty Technique, Nasser Simforoosh and Mohammad H. Radfar Volume 2008, Article ID 536428, 6 pages Technique of Intravesical Laparoscopy for Ureteric Reimplantation to Treat VUR, Atul A. Thakre and C. K. Yeung Volume 2008, Article ID 937231, 3 pages Laparoscopic Extravesical Ureteral Reimplantation: Technique, John-Paul Capolicchio Volume 2008, Article ID 567980, 5 pages Vesicoscopic Ureteral Reimplantation: A Minimally Invasive Technique for the Definitive Repair of Vesicoureteral Reflux, Venkata Jayanthi and Ashay Patel Volume 2008, Article ID 973616, 6 pages Robotic-Assisted Laparoscopic Management of Vesicoureteral Reflux,ThomasLendvay Volume 2008, Article ID 732942, 4 pages Strengths and Pitfalls of Meta-Analysis Reports in Vesicoureteral Reflux, K. Afshar and A. E. MacNeily Volume 2008, Article ID 295492, 6 pages Hindawi Publishing Corporation Advances in Urology Volume 2008, Article ID 767138, 1 page doi:10.1155/2008/767138 Editorial The Changing Concepts of Vesicoureteral Reflux in Children Walid A. Farhat1 and Hiep T. Nguyen2 1 The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8 2 Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA Correspondence should be addressed to Walid A. Farhat, [email protected] Received 3 December 2008; Accepted 3 December 2008 Copyright © 2008 W. A. Farhat and H. T. Nguyen. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Over the past two decades, tremendous progress has been long-term outcomes. Consequently, many controversies now made in the diagnosis, management, and treatment of vesi- exist for the management of VUR. coureteral reflux (VUR), thus changing our understanding In this special issue, we have assembled 23 articles of this entity from being surgical to medical disease. addressing the controversies associated with the diagnosis, VUR is most often identified following investigation for management, and treatment of VUR. We hope to provide other urinary tract problems such as urinary tract infection some understanding of what we know and do not know (UTI) and prenatal hydronephrosis or in evaluation of a about VUR and stimulate scientific evaluations of VUR and family history of VUR. The prevalence of VUR ranges from its management. 0.4% to 1.8% of asymptomatic children but increases to 30– 50% in children with a history of a febrile UTI. VUR in Walid A. Farhat the presence of a UTI can lead to pyelonephritis and renal Hiep T. Nguyen injury with permanent scarring (reflux nephropathy). Reflux nephropathy remains an important cause of renal failure in children and the subsequent need for renal transplantation in the United States. Furthermore, it is evident that VUR may be a component of dysfunctional lower urinary tract (i.e., dysfunctional elimination syndrome) and thus has further enhanced our understanding of this entity. Since VUR may resolve spontaneously in the majority of patients without requiring surgical intervention, chil- dren with VUR are traditionally managed with antibiotic prophylaxis with the primary goal of preventing the long- term complications associated with VUR such as renal scarring, hypertension, and renal insufficiency/failure by the prevention of urinary tract infection. However, surgical correction may be required if there is a break-through UTI or failure to resolve after a period of observation. More recently, the management and rationale for the treatment of VUR have been re-evaluated. The risks and benefits of diagnosing VUR are being questioned from a health impact and financial level. For instance, the efficiency of prophylactic antibiotic in the management of VUR is being challenged. Furthermore, alternative and less invasive methods of treating VUR are being proposed with undefined Hindawi Publishing Corporation Advances in Urology Volume 2008, Article ID 459630, 3 pages doi:10.1155/2008/459630 Review Article Vesicoureteral Reflux: Where Have We Been, Where Are We Now, and Where Are We Going? Gordon A. McLorie School of Medicine, Wake Forest University Baptist Medical Center, Winston Salem, NC 27157, USA Correspondence should be addressed to Gordon A. McLorie, [email protected] Received 3 April 2008; Accepted 11 August 2008 Recommended by Walid A. Farhat We present a retrospective review of the scientific and clinical advances, extending over four decades, which have linked vesicoureteral reflux, with renal injury, and urinary tract infection. We have traced the original studies, coupled with advances in technology which led to the awareness, and ability to detect and diagnose the problems early in childhood. These advances progressed through clinical studies which defined the epidemiology of both reflux and urinary tract infection. Along with these diagnostic advances, there were numerous surgical developments, which allowed progressive improvements in the outcomes and effectiveness of a variety of treatment modalities. All of this literature leads us to the current era, when several clinical trials are currently underway in an effort to more fully define the most efficacious and safe methods to treat vesicoureteral reflux and associated urinary tract infection. Copyright © 2008 Gordon A. McLorie. 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