Abstract
One hundred and four children (48 boys and 56 girls, ranging in age from 3 months to 15 years, and follow-up period of more than 2 years in all) with “primary” vesicoureteral reflux (VUR) were retrospectively analyzed with particular emphasis on resolution of VUR and occurrence of renal scar. All underwent cystoscopic examinations which failed to demonstrate any organic vesicourethral obstruction, and all were neurologically normal. The patient population was divided into 2 groups based on cystometric findings. Group 1 consisted of 74 patients with unstable bladder and Group 2 consisted of 30 patients without unstable bladder. Although both groups were initially kept under antibacterials, in Group 1 frequent voiding and anticholinergics were maintained until the bladder stabilized by itself. There was no difference in the grade of reflux between the two groups. The rate of spontaneous resolution of reflux was 18% in group 1 in which more than 60% of the patients were with high grade reflux, while in Group 2 it was 17%, similarly to Group 1, but all were with low grade reflux. The presence or absence of renal scar and its subsequent evolution were determined in 73 patients in whom serial urograms were available enough to evaluate nephrographic renal outline. The incidence of renal scar at the first visit was 26% in Group 1 and 36% in Group 2. New formation of renal scar was not found in either group. The progression of preexisting renal scar was seen only in Group 1 (5/55 patients, 9%), and not in Group 2 (0/18 patients, 0%). Retrospectively, all the progression occurred within 2 years of follow-up and were seen either in the poor-compliants to anticholinergics (2 patients) or in those detected relatively late with advanced reflux nephropathy (3 patients). These data suggest that there was a high incidence of unstable bladder in “primary” VUR, even a high grade VUR has a chance to resolve by itself with stabilization of the bladder, and its early detection and initiation of proper managements are mandatory to prevent the formation and progression of renal scar. Even when antireflux surgery precedes, control of unstable bladder is mandatory.
