Clinical features of vesicoureteral reflux in infants and outcome of conservative therapeutic approach.

Abstract

We evaluated the clinical features of vesicoureteral reflux (VUR) detected in infants and the outcome of a conservative therapeutic approach. Consecutively 67 infants with VUR (55 boys and 12 girls) were enrolled in this study. Of the 67 patients, 34 had primary and 33 had secondary VUR. Underlying abnormalities in secondary VUR were: posterior urethral valve (PUV) in 7; bulbar urethral stenosis (Cobb's collar) in 16; neurovesical dysfunction (NVD) in 8, and others in 2. Transurethral incision was performed in patients with PUV or Cobb's collar. NVD was managed with intermittent catheterization. All patients were followed with antibiotic prophylaxis. No significant difference was found in VUR grades between primary and secondary VUR. Spontaneous resolution of VUR was noted in 31% of primary and 54% of secondary VUR (p<0.02). VUR downgrading including VUR resolution was also noted more often in secondary than in primary VUR (80 vs. 48%; p<0.01). The distribution of primary and secondary VUR in infants was almost equal in our study. Resolution of reflux is seen more often in secondary than in primary cases. Thus, early detection and proper management of underlying lower urinary tract abnormalities, either structural or functional, are crucial in the treatment of VUR in infants.