Abstract
We evaluated clinical characteristics of primary vesicoureteral reflux (VUR) in infants in a 30-year period in Brazil with special reference to the relation of renal parenchymal damage to urinary tract infection and gender. From 1975 through 2005, 417 girls (81.6%) and 94 boys (18.4%) with all grades of reflux were retrospectively reviewed. Patients were categorized by the worst grade of reflux, maintained on antibiotic prophylaxis and underwent yearly voiding cystourethrography until the reflux was resolved. VUR was considered resolved when a follow-up cystogram demonstrated no reflux. Surgical correction was recommended for those who fail medical therapy, severe renal scarring or persistent VUR. Grades I to V VUR resolved in 87.5%, 77.6%, 52.8%, 12.2% and 4.3%, respectively. Renal scars were present at presentation in 98 patients (19.2%). Neither gender nor bilaterality versus unilaterality was a helpful predictor of resolution. The significant difference was found among the curves using the log rank (p<0.001) or Wilcoxon (p<0.001) test. Despite the current use of screening prenatal ultrasound, many infants are still diagnosed as having vesicoureteral reflux only after the occurrence of urinary tract infection in our country. Scarring may be associated to any reflux grade and it may be initially diagnosed at any age but half of the scars are noted with higher grades of reflux (IV and V). The incidence of reflux related morbidity in children has significantly diminished over the last three decades.
Highlights
Vesicoureteral reflux (VUR) is a common pediatric problem
VUR was detected by voiding cystourethrograms (VCUGs) and the grade classified according to the International Reflux Study Committee [3]
Patients were kept under continuous prophylaxis and had urine culture collected on a monthly basis, upper urinary tract assessment with renal ultrasonography (RUS) every six months and intravenous urography or scintigraphy and VCUG once a year
Summary
Vesicoureteral reflux (VUR) is a common pediatric problem. The possibility of renal damage due to VUR and renal function impairment and hypertension gives the necessary impetus for the diagnosis or exclusion of this problem [1]. It was thought that medical and surgical management represented efficacious treatment options [1,2]. Both treatment forms have advantages and disadvantages that must be taken into account and shared with the parents when choosing the best approach. The primary endpoint of this study was defining the rates of spontaneous resolution for patients with VUR in our country. These data may be helpful to determine the need for surgical intervention and the proper follow-up schedule in patients on antibiotic prophylaxis. Besides finding out the overall resolution rate, we saw if we could find differences between the groups according to the period diagnosis was carried out
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