Zusammenfassung
Der vesikoureterale Reflux (VUR) ist eine dynamische Erkrankung, deren Verlauf von einer Vielzahl von Risikofaktoren abhängt und das therapeutische Vorgehen wird weiterhin kontrovers diskutiert. Das Spektrum der Behandlungsoptionen reicht von reinem Zuwarten bis zur offenen Operation. Die Auswahl der geeigneten Therapieform wird von Alter, Geschlecht, der Vorgeschichte in Bezug auf Pyelonephritiden und Nierenparenchymnarben, Blasen- und Darmentleerungsstörungen, dem Beschneidungsstatus und auch der Präferenz der Eltern beeinflusst. Die Verwendung der antibiotischen Prophylaxe ist zunehmend umstritten, wobei insbesondere die Resistenzentwicklung Besorgnis erregt. Die konsequente Behandlung bestehender Blasen- und Darmentleerungsstörungen als auch die Zirkumzision im Säuglingsalter kann das individuelle Risiko des betreffenden Kindes erheblich verringern, weshalb diese Behandlungsoptionen immer bedacht werden sollten. Der Artikel befasst sich ausschließlich mit dem primären VUR.
Abstract
Primary vesicoureteral reflux (VUR) is a dynamic disease with several factors influencing its course. Therapeutic options range from watchful waiting to open surgery. Multiple risk factors for the development of pyelonephritis are identified, which then determine the decision for the appropriate treatment option. They include age, gender, history of pyelonephritis and renal scarring, bladder and bowel dysfunction (BBD), circumcision status and parental preference. The use of continuous antibiotic prophylaxis (CAP) is becoming increasingly controversial with antibiotic resistance being a major concern. Aggressive treatment of BBD and infant circumcision can greatly reduce the risk for pyelonephritis and should always be considered and discussed. This article is soley concerned with primary VUR.
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Schröder, A. Vesikoureteraler Reflux. Urologe 56, 1158–1163 (2017). https://doi.org/10.1007/s00120-017-0453-x
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DOI: https://doi.org/10.1007/s00120-017-0453-x
Schlüsselwörter
- Refluxkorrektur, operative
- Pyelonephritis
- Blasenentleerungsstörung
- Darmentleerungsstörung
- Harnwegsinfektion