Heavy Scarring in the Unilateral Refluxing Kidney May Be Sign of Contralateral Reflux After Reimplantation

Abstract

Purpose We investigated the role of ipsilateral heavy scarring in the unilateral refluxing kidney for the occurrence of contralateral reflux after reimplantation. The question is: if heavy scarring is a sign of severe dysplasia, can occurence of contralateral reflux be effected by this unilateral sever dysplasia? Material and Methods Forty-five patients (23 male 22 female, mean age 5.3+/- 3.3) who had undergone unilateral reimplantation were included into the study. Presence of multiple scars in renal scan and differential function being less than 30% with diffuse parenchymal damage were accepted as heavy scarring. 19 patients had grade 3, 17 had grade 4, and 9 had grade 5 VUR. Results There were 2 patients with persistent ipsilateral reflux. Contralateral reflux developed in 7 patients (grade 1 in one patient, grade 2 in two patients,grade 3 in four,and grade 5 in one). Bilateral reflux developed only in the patient with ectopic ureter, and recurring reflux was not seen in other anatomic disorder. No relation was found between the preoperative grade, type of reimplantation and reflux to the contralateral kidney. Development of contralateral reflux in patients with heavy ipsilateral scarring was significantly higher (table)(p=0.05). Contralateral reflux was found in 3 patients out of five with heavy scarring and younger than 5 years of age. Reflux recovered within 24.6+/-12.2 (7-41) months in the average. IPSILATERAL SCAR No/minimal scarring Heavy scarring TOTAL NO CONTRALATERAL REFLUX 31 7 38 CONTRALATERAL REFLUX + 3 4 7 TOTAL 34 11 45 Table. The effect of presence of ipsilateral heavy scarring on occurrence of contralateral reflux (p=0.05) Conclusions We found that presence of heavy scarring in ipsilateral kidney may have a role for the prediction of contralateral reflux developing after the unilateral ureteroneocystostomy escpecially in young children. It can be related with primary trigonal disease or pop-off mechanism.