A 5-year retrospective analysis of patients with primary vesicoureteral reflux undergoing open surgery; an assessment of 60 patients

Abstract

Vesicoureteral reflux (VUR) describes the backward flow of urine from the bladder to the ureter and/or kidney. In this study, 60 patients below 18 years of age diagnosed with primary VUR in our clinic between 2010 and 2014 and undergoingureteroneocystotomy using various open surgery techniques were evaluated retrospectively. Diagnosis of VUR was based on voiding cystourethrography (VCUG). Urinary system ultrasonography (USG) was performed to exclude possible additional pathologies and to monitor the clinical course. Static renal scintigraphy (DMSA) was performed to determine preoperative renal scars and loss of function. Severity of reflux was divided into 5 degrees (1-5) following the criteria set out by the International Reflux Study Group. Patients were divided into 3 groups, mild (grade 1-2), moderate (grade 3) or severe (4-5) VUR. Females constituted 71.7% of the patients (n=43). Mean age at time of diagnosis of VUR was 6.25 years and mean age at time of surgery was 6.36 years. Fifteen percent of VURs were on the right side (n=9), 31.7% were on the left side (n=19) and 53.3% were bilateral (n=32). Advanced grade VUR (grade 4-5) was determined in 68.3% of patients. Loss of function was observed in 27.7% (n=16) of patients undergoing DMSA, and scar and loss of function were determined in 46.7% (n=28). The most common pathogen grown in preoperative urine cultures was Escherichia coli (65%). No significant difference was observed between the VUR grades in terms of age at time of diagnosis or age at time of surgery (p=0.682 and p=0.673, respectively). No statistically significant correlation was also determined between gender and VUR grade (p=0.859). No patient required a second surgical procedure. At postoperative follow-up, hypertension was observed in two patients, and these received antihypertensive therapy. Hypertension was observed over the long-term in one patient and was controlled with antihypertensive therapy. In conclusion, a high level of loss of renal function and scars was determined, in parallel with greater age at time of diagnosis of VUR and at time of surgery, in our region.