The changing paradigm for the management of pediatric vesicoureteral reflux.

Pediatric vesicoureteral reflux is recognized in children whose ureterovesical valve is incompetent, resulting in flow of urine from the kidney to the bladder and back to the kidney. It is a disease process with a rapidly changing management paradigm; more research is being done to determine the long-term outcomes for those affected in both childhood and adulthood. This article will provide a brief overview of current management and discuss the role of the advanced practice registered nurse with families.

A critical pathway for successful outpatient ureteral reimplantation: a nursing perspective.

Vesicoureteral reflux is a common pediatric urologic condition. Traditionally, surgical treatment of this condition requires a hospital stay of 1 to 6 days. Our experience has shown that both unilateral and bilateral extravesical ureteral reimplantation can be performed safely in the ambulatory surgery setting. Our perianesthesia care revolves around the concept of family-centered care. We have found that the key to our critical pathway involves both the patient and the family in every part of perianesthesia care. This "team" approach can be adapted for any pediatric procedure.

Obstructive uropathy: considerations for the nephrology nurse.

Obstructive uropathy is the cause of renal failure in 16.2% of pediatric patients who undergo renal transplantation, 12.9% of those on dialysis, and 23.1% of those with chronic renal insufficiency, according to the annual report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Successfully caring for patients with obstructive uropathy requires an understanding of the various congenital anomalies that create obstructive uropathy, the urological interventions used to treat them, management of the patient, and the nursing care required.

Mothers' coping in chronic childhood illness: the effect of presymptomatic diagnosis of vesicoureteric reflux.

UNLABELLED: AIMS OF THE STUDY WERE TO: Assess coping strategies of mothers who have a child with vesicoureteric reflex (VUR), determine mothers' understanding of VUR before and after diagnosis, assess mothers' perceived needs for support when coping with their child's VUR and compare the above aims between two groups of mothers of children with VUR. BACKGROUND: Vesicoureteric reflex (VUR) is a chronic, congenital, asymptomatic condition which when combined with urinary tract infection (UTI) can result in reflux nephropathy (RN), contributing to 20% of kidney transplants. Unfortunately, VUR is not usually diagnosed until after proven UTI, by which time RN has often developed. However, recent research, the familial ureteric reflux study (FURS) identified for the first time VUR in a cohort of new-borns investigated because of family history. Early detection and prompt treatment of UTI in the presence of VUR may significantly reduce the development of RN but this requires extreme vigilance by mothers, who are usually the primary carers. DESIGN: As mothers' experiences and perceptions were the focus, a qualitative design using semistructured, in-depth interviews was used. After obtaining ethical approval, mothers of 15 children with VUR diagnosed presymptomatically (i.e. after participation in the FUR study) and mothers of 14 children with VUR diagnosed post symptomatically were selected using a theoretical sampling matrix. All mothers gave informed consent and interviews were taped, transcribed and analysed using the 'Framework' technique. FINDINGS: Findings for both groups fall into three discrete phases: the prediagnostic, diagnostic and postdiagnostic. Analysis showed that mothers in the post symptomatic diagnosis group experienced most problems in coping, particularly because of difficulty in engaging medical intervention in the prediagnostic phase. Generally, mothers in the presymptomatic group coped well apart from those who themselves had VUR and/or RN who expressed guilt about their child inheriting the condition and consequently difficulty in coping. CONCLUSION: Early diagnosis of VUR improved mothers' coping. However, both groups identified a major need for improved information provision and support to assist coping with the sustained uncertainty of the condition.

Vesicoureteral reflux.

Vesicoureteral reflux, the regurgitation of urine from the bladder into the ureters, varies in severity. Controversy persists in relation to the cause, diagnosis, significance, and treatment of this condition. The practitioner's role in early referral and treatment of urinary tract infection is important to prevent renal damage. Patient and family support and education about reflux, diagnosis, and follow-up is crucial. Early diagnosis and optimal management will preserve maximal renal function, and patient education will foster compliance and quality care.