POSTOPERATIVE MEDIUM-TERM FOLLOW-UP OF PATIENTS WITH BILATERAL, MASSIVE PRIMARY VESICORENAL REFLUX AND REDUCED RENAL-FUNCTION AT PRESENTATION

We report the results of a medium-term followup study of 52 patients w ith bilateral, massive primary vesicorenal reflux (PVRR) with renal da mage at presentation. Ten infants between 2 and 5 months of age, with a total of 19 renal units, had a temporary vesicostomy followed by ure teral reimplantation after 12-15 months; 42 patients with 81 renal uni ts had primary ureteral reimplantation. The postoperative observation period covered 9.5 years on average (20 months - 21.5 years). The stud y showed that: (1) urinary specific gravity remained reduced in about 61% of patients; (2) proteinuria improved significantly, in a direct p roportion to the favorable evolution of renal function; (3) the freque ncy of acute pyelonephritis decreased significantly from 98% to 23%. P ostoperatively, 27 patients (51%) had one or more episodes of urinary tract infection (UTI) and 12 (23.0%) still had episodes of acute pyelo nephritis. (4) At follow-up 7 patients (13.5%) had stable hypertension , while 3 others had unstable hypertension (19.2%); 8 had chronic rena l insufficiency or end-stage renal disease. When only adolescents more than 12 years old were considered, the incidence of hypertension incr eased to 34.4% (10/29). (5) Some renal scarring developed despite succ essful antireflux surgery, and parenchymal growth, which was severely impaired prior to surgery, restarted although it remained below - 2 st andard deviations from the mean. (6). In the overall series glomerular filtration rates (GFR) significantly improved after successful surger y. However, this improvement was much more evident in patients operate d upon within the Ist year of life and in those who had had a temporar y vesicostomy. In the subgroup of patients operated upon after 6 years of age, successful surgery had no effect on the further decline of re nal function when this was already severely compromised. We conclude t hat early antireflux surgery or, in selected cases, temporary vesicost omy followed by ureteral reimplantation was effective in significantly improving GFR and sharply decreasing febrile UTIs in patients with ma ssive bilateral PVRR and renal damage at presentation.