DIRECT VESICOURETERAL SCINTIGRAPHY - QUANTIFYING EARLY OUTCOME PREDICTORS IN CHILDREN WITH PRIMARY REFLUX

This study quantifies some of the outcome predictors in a group of chi ldren with primary vesicoureteral reflux who were initially managed me dically. Methods: We studied 133 patients with primary reflux for 7.1 +/- 2.2 yr. Direct vesicoureteral scintigraphy (DVS) was used to prosp ectively measure the absolute bladder volume at which reflux began and the maximum volume of urine refluxed into the ureters during the fill ing and voiding phases of their first two DVS studies. Findings were r elated to outcome as defined by spontaneous resolution or the eventual need for reconstructive surgery. Results: Medical management eventual ly failed in 35% of this sample. Patients who did not begin to reflux until their bladders had been filled to more than 60% total bladder ca pacity had a substantially smaller risk of surgery than those who bega n to reflux at smaller bladder volumes. Patients who refluxed a volume of urine back into their ureters that was less than about 2% of their total bladder capacity had a substantially smaller risk of surgery th an those who refluxed more than 2%. The difference between groups was significant for both DVS variables (p < 0.001). Conclusion: Quantitati ve DVS contributes to the assessment of prognosis in children with ves icoureteral reflux who are managed medically.