Abstract
Vesicoureteral reflux (VUR) is the regurgitation of bladder urine into the upper urinary tract. Among the problems concerning vesicoureteral reflux, renal damage due to or in association with reflux has become one of the most important topics. In this paper we reviewed children with primary VUR who underwent antireflux surgery, and analysed the surgical effect on reflux nephropathy.
Between July 1973 and December 1988, 361 children have been operated on in our institute. The incidence of patients undergoing antireflux surgery was 40% among 901 children with primary reflux treated during the same period. The complications of surgery consisted of persistent renux, obstruction and bladder diverticulum. In total 95% of surgical procedures were successful after a single operation. The incidence of postoperative pyelonephritis was 6.6 per cent which was far lower than the preoperative one. Renal scarring was detected in 36% of kidneys at the first examination in the surgical group. Among 63 kidneys which showed progression of renal scarring, only 9 (2% among the surgical group) revealed the pathological change on the examination taken at later than 2 years after the operation. The prevalence of a small kidney was 18%, and accelerated growth after successful surgery was only exceptional. Temporary improvement of renal function was observed in only 3 of 21 children with renal dysfunction who were followed for more than 1 year. Deterioration of renal function was caused again within 6 months to one year. Antireflux surgery had only little influence on the improvement of renal function in this series.
We emphasize the need for early detection and management of reflux to prevent progression of renal damage.
