Renal and Bladder Functional Status at Diagnosis as Predictive Factors for the Outcome of Primary Vesicoureteral Reflux in Children

Purpose

We studied the relationship between renal and bladder functional status at diagnosis and spontaneous resolution of reflux in young children with primary vesicoureteral reflux.

Materials and Methods

Children with grade III or greater vesicoureteral reflux were recruited for the study. At entry each patient underwent voiding cystourethrogram, renal ultrasound, isotope renogram, and natural filling and conventional filling urodynamic studies. Patients were then divided into 4 groups—group 1 had normal renal and bladder function, group 2 had abnormal renal and normal bladder function, group 3 had normal renal and abnormal bladder function, and group 4 had abnormal renal and bladder function. Correlation between renal and bladder functional status with reflux resolution at a minimum followup of 24 months was evaluated.

Results

A total of 82 patients (mean age 3.8 years) were prospectively evaluated and followed. There were 18 patients (13 males and 5 females) in group 1, 19 (13 and 6) in group 2, 19 (18 and 1) in group 3 and 26 (22 and 4) in group 4. Complete resolution of vesicoureteral reflux occurred in 17 patients (94%) in group 1 and 7 (37%) in group 2. None of the patients from group 3 or group 4 achieved complete vesicoureteral reflux resolution. Reflux grade remained unchanged in 15 patients (79%) in group 3 and 20 (77%) in group 4.

Conclusions

Resolution of vesicoureteral reflux significantly correlated with renal and bladder functional status at diagnosis. Normal renal and bladder function at diagnosis is highly predictive of complete resolution of vesicoureteral reflux, whereas abnormal renal and bladder function is prognostic for persistence of reflux.

Key Words:  vesico-ureteral reflux , urinary tract infections , bladder , neurogenic , cicatrix , urodynamics

Abbreviations and Acronyms:  DMSA, dimercapto-succinic acid , UD, urodynamic , US, ultrasound , UTI, urinary tract infection , UVJ, ureterovesical junction , VCUG, voiding cystourethrogram , VUR, vesicoureteral reflux