Evaluation of the Pediatric Patients with Primary Vesicoureteral Reflux- Single Center Study

Objective: Vesicoureteral reflux (VUR) with bladder and bowel dysfunction (BBD) predispose to recurrent urinary tract infections (UTIs), thus increase the risk of kidney damage. In this study, we retrospectively evaluated the clinical characteristics and outcomes of children with primary VUR. Methods: 115 patients diagnosed with primary VUR were enrolled. The patients were grouped according to VUR stages and demographic characteristics, laboratory and imaging studies, medical and surgical treatment options were evaluated. Results: Majority of the patients were females (82.6%). Mean follow-up time was 3.6 +/- 1.1 years. At admission, 60% and 62.6% of the patients had recurrent UTIs and BBD, respectively. There was grade I-II VUR, grade III VUR and grade IV -V VUR in 26.8%, 51.7% and 21.5% of 149 renal units, respectively. Ultrasonographic abnormalities and scarring on technetium (Tc)-99m dimercaptosuccinic acid (DMSA) were significantly higher in high grade VUR (p=0.001 and p=0.04, respectively). Patients with scarring had significantly more recurrent UTIs, BBD and ultrasonographic abnormalities (p=0.03, for all). 22.6% of the patients underwent surgery. Control voiding cystourethrography (VCUG) of 67 renal units showed spontaneous resolution in 38.8%, whereas surgical correction/regression was detected in 53.7%. Patient outcomes were favorable with decreased recurrent UTIs (15.6%) and no progression into chronic kidney disease (CKD). Conclusion: Risk of renal scarring, an important finding of reflux nephropathy and subsequent CKD, was significantly higher in patients with high grade VUR, recurrent UTIs and BBD. Urinary ultrasonography was reliable in predicting scarring. Children with recurrent UTIs and/or BBD as well as urinary ultrasonography (USG) abnormalities should be evaluated for VUR.