Vesico-ureteric reflux in the young infant with follow-up direct radionuclide cystograms: the medical and surgical outcome at 5 years old.

Abstract

To compare the 5-year outcome of 82 infants with vesico-ureteric reflux (VUR) against the initial (< 1 year) and follow-up results of the direct radionuclide cystogram (DRC). An initial DRC was taken at a mean age of 0.6 years and the follow-up study at 1.7 years. VUR was graded using 'one-third bladder volume' grades (BVG) of 'low', 'moderate', 'high' and 'void', with 'low' considered the most severe. Renal scintigraphy was used to assess renal scarring in 80 of the 82 patients. The outcome at a minimum age of 5 years was defined as resolved reflux, those with corrective surgery or those still being medically followed. Those being followed comprised 29%, corrective reflux surgery 17% and resolved 54% of the patients. Children with VUR grades of 'high' or 'moderate' (as the worst grade either side) were more likely to have resolution than those with 'low' (by four and two times, respectively). Reflux at 'low' bladder volume was 2.6 times more likely to be associated with renal scarring than the other grades combined. 'Low' reflux was present in nine of 14 children needing surgery. There was a linear relationship between VUR grade and the scintigraphic findings. The severity of VUR can be assessed from the bladder-volume graded DRC. Continuing VUR at 'low' BVG is associated with increased renal scarring, resistance to natural resolution and corrective reflux surgery.