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Vesikoureteraler Reflux

Diagnose und Therapieempfehlungen

Vesico-ureteral reflux

Diagnosis and treatment recommendations

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Zusammenfassung

Hintergrund

Der vesikoureterale Reflux (VUR) ist eine der häufigsten urologischen Erkrankungen im Kindesalter. Bei ungefähr jedem 3. Kind mit einem Harnwegsinfekt (HWI) lässt sich ein VUR nachweisen. Beweisend für einen VUR ist der Nachweis eines Rückflusses von Urin in den Ureter oder die Nieren. In unklaren Fällen kann bei Verdacht auf einen Reflux ein PIC-Zystogramm („positioned instillation of contrast agent“) durchgeführt werden.

Ziel

Da insbesondere ein niedriggradiger VUR eine hohe Maturationswahrscheinlichkeit hat, erfolgt beim Säugling im 1. Lebensjahr zunächst eine antibiotische Prophylaxe. Nach dem 1. Lebensjahr sollte eine Reevaluation mit weiterer Therapieplanung erfolgen. Ziel jeder Therapie ist die Vermeidung von Nierenschäden.

Therapie

Entscheidend für die Wahl der jeweiligen Therapieform ist das individuelle Risiko des Kindes Narben zu bilden. Dies ist vorwiegend abhängig von Refluxgrad, Alter und Geschlecht des Kindes sowie von der Compliance der Eltern. Prinzipiell stehen als Therapieoptionen die konservative, die endoskopische oder die offen-chirurgische Refluxtherapie zur Verfügung.

Schlussfolgerung

Die Therapieentscheidung sollte individuell mit den Eltern unter Berücksichtigung aller vorliegender Befunde getroffen werden.

Abstract

Background

Vesico-ureteral reflux (VUR) is one of the most common urologic diseases in childhood. About every third child that presents with a urinary tract infection (UTI) has urinary reflux to the ureter or kidney. Demonstration of a backflow of urine into the ureters or kidneys proves vesicoureteral reflux. In unclear cases, a positioned instillation of contrast agent (PIC) cystogram might be performed and is able to prove vesico-ureteral reflux.

Objectives

Since low-grade VUR has a high probability of maturation and self-limitation, infants with VUR should be given prophylactic antibiotics during their first year of life, reevaluating the status of VUR after 12 months. The aim of any treatment is to prevent renal damage.

Therapy

The individual risk of renal scarring is decisive for the choice of adequate therapy. This risk is mainly dependent on reflux grade, age, and gender of the child as well as parental therapy adherence. In principle, therapeutic options include conservative as well as endoscopic or open surgical antireflux therapies.

Conclusion

Decisions on treatment should be made individually with parents taking into account all the findings available.

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Authors and Affiliations

  1. Urologische Klinik und Poliklinik der Ludwig-Maximilians-Universität München, LMU, Klinikum Großhadern, Marchioninistr. 15, 81377, München, Deutschland

    J. Straub, M. Apfelbeck, A. Karl, W. Khoder, K. Lellig, S. Tritschler, C. Stief & M. Riccabona

Authors
  1. J. Straub
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  2. M. Apfelbeck
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  3. A. Karl
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  4. W. Khoder
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  5. K. Lellig
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  6. S. Tritschler
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  7. C. Stief
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  8. M. Riccabona
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Corresponding author

Correspondence to J. Straub.

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Interessenkonflikt

J. Straub, M. Apfelbeck, A. Karl, W. Khoder, K. Lellig, S. Tritschler, C. Stief und M. Riccabona geben an, dass kein Interessenkonflikt besteht.

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Straub, J., Apfelbeck, M., Karl, A. et al. Vesikoureteraler Reflux. Urologe 55, 27–34 (2016). https://doi.org/10.1007/s00120-015-0003-3

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  • DOI: https://doi.org/10.1007/s00120-015-0003-3

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