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제목	A Case Report on Vesicoureteral Reflux in Healthy Adult Woman With Recurrent Urinary Tract Infections
저자	Shin Young Lee
출판정보	2025; 2025(1):
키워드	Macroplastique® injection therapy, VUR, Vesicoureteral Reflux, recurrent UTI
초록	A 24-year-old woman visited emergency department with fever, left flank pain and typical urinary symptoms including dysuria and urinary frequency. She had no other underlying comorbidities but experienced 5 recurrent episodes of acute pyelonephritis (APN) for a total of 2 years. Initial laboratory tests showed elevated inflammatory markers (white blood cell (WBC) count 18,700/mm3, C-reactive protein (CRP) 15.5 mg/dL) with normal renal function, while urinalysis detected bacteriuria and trace proteinuria without pyuria. Contrast-enhanced computed tomography revealed a smaller size of left kidney (8.5 cm) with multifocal decreased contrast uptake, consistent with left pyelonephritis. The patient started on ceftazidime, and later switched to ciprofloxacin after identifying Enterococcus faecalis (>100,000 CFU/mL). Recurrent left-sided APN and chronic renal changes led to further evaluation, revealing grade III vesicoureteral reflux (VUR) on the left side via voiding cystourethrogram (VCUG). Additional studies, including cystoscopy, uroflowmetry, and Tc-99m Dimercaptosuccinic acid (DMSA) renal scan, showed no other abnormalities but confirmed reduced size and segmental decreased uptake in the left kidney. After 10-day course of intravenous antibiotics, the infection improved (CRP 1.1 mg/dL), and the patient was discharged on prophylactic trimethoprim-sulfamethoxazole. She later underwent bulking agents (Macroplastique®) injection therapy for VUR. No additional urinary tract infections occurred within 6 months following the Macroplastique® injection therapy. This case underscores the importance of considering VUR as an underlying cause of recurrent UTIs in adults, even in the absence of conventional risk factors. Persistent unilateral infections, as observed in this patient, should prompt further evaluation for structural abnormalities of the urinary tract. Given the potential for VUR to contribute to renal dysfunction and end-stage kidney disease in adults, timely diagnosis and intervention are crucial for favorable outcomes. While long-term outcomes of endoscopic bulking agents in adult VUR remain underexplored, this case suggests its potential as a viable therapeutic option.
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