Predictive factors for spontaneous resolution of congenital High-Grade infantile Vesicouretral Reflux

Abstract

PURPOSE The aim was to identify prognostic factors for spontaneous resolution of congenital high-grade vesicoureteral reflux (VUR). MATERIAL AND METHODS 115 infants (85 boys and 35 girls) were included at median age 2.7 months. 74% were diagnosed after urinary tract infection (UTI) and 26% after prenatal ultrasound. VUR was bilateral in 70% and of maximum grade III in 15%, grade IV in 45% and grade V in 40%. All have been followed with repeated video-VUCG, renal scintigrams (MAG-3 and DMSA) and 51Cr-EDTA-Clearances. Median follow-up time was 36 months. RESULTS The overall spontaneous resolution rate (to grade II or less) was 39%. Significantly lower resolution was found in univariate Cox analysis, illustrated in Kaplan Meier survival curves, in those with renal damage, breakthrough UTI, bladder dysfunction, high bladder capacity, impaired renal function (lowered GFR), and reflux occurring without increase in pressure early during filling. Voiding reflux was connected to a high rate of spontaneous resolution. The resolution rate was also directly related to grade of VUR. There was no significant difference in resolution rate between boys and girls, pre or postnatal diagnosis, uni or bilateral VUR at start. CONCLUSIONS The overall resolution rate in congenital high-grade vesicoureteral reflux was high during the first years of life. A number of factors have been identified as important in the prediction of the long-time outcome of VUR in this study. Of these factors renal damage, bladder dysfunction and recurrent UTI have been shown to be the strongest independent predictors in a stepwise multivariate Cox analysis.