RENAL-FUNCTION UP TO 16 YEARS AFTER CONDUIT (REFLUXING OR ANTIREFLUX ANASTOMOSIS) OR CONTINENT URINARY-DIVERSION .2. RENAL SCARRING AND LOCATION OF BACTERIURIA

Objective To evaluate the importance of refluxing versus anti-reflux ureteric implantation for the development of renal scarring in patients with a conduit or continent urinary diversion and for the incidence of bacteriuria in the upper urinary tract of patients with a conduit. Patients and methods Renal scintigraphy using Tc-99m-dimercaptosuccinic acid was performed on 32 of 37 evaluable patients from a prospective, randomized study at a mean of 150 months (range 102-198) after urinary diversion, In five patients with a conduit diversion and unilateral renal scarring, urine was sampled for culture from the proximal end of the conduit and from both renal pelvices by direct percutaneous aspiration. Results Of 35 renal units (18 patients), studied after conduit diversion. scarring was found in 11 (two grade I, six grade II and three grade III) of 17 with refluxing anastomosis and in six (one grade I, four grade II and one grade III) of 18 with anti-reflux anastomosis (P = 0.06). Of 25 renal units (14 patients) after continent diversion, 16 showed scarring (seven grade I and nine grade II), Bacteriuria was found in four of five upper urinary tracts with a refluxing anastomosis, but in only one of live with an anti-reflux anastomosis. In these five patients scarring was present in all kidneys with refluxing anastomosis. Conclusion Anti-reflux ureteric anastomosis seems to be important for preventing scarring and bacteriuria in the upper urinary tract of patients with a conduit urinary diversion. Despite the anti-reflux technique of ureteric implantation, most patients with a continent reservoir had renal scarring, though it was generally less severe than in patients with a conduit urinary diversion.