PRIMARY VESICOURETERAL REFLUX IN INFANTS WITH A DILATED FETAL URINARY-TRACT

Vesicoureteral reflux (VUR) was recognized neonatally by voiding cysto graphy in 25 of 117 infants with a dilated fetal urinary tract. There was a male pre-ponderance (76%) and a high percentage (40%) of associa ted urinary malformations. Thirtynine refluxing units were studied. Al l grades of VUR were detected but gross dilating VUR dominated (59%). Spontaneous resolution was excellent in lower grades of VUR but was po or in gross VUR. Surgery was successfully performed in 13 renal units of nine patients with gross reflux [8], additional ipsilateral malform ations [4], or pyelonephritis during antibiotic prophylaxis [1]. Segme ntal renal scars developed in four kidneys after urinary infections, a nd a diffuse parenchymal lesion was noted in nine kidneys even at birt h. One boy with duplication had a non-functioning refluxing system. Ou r results in a small number of infants show differences to children wi th VUR detected after urinary infections and seem to support the exist ence of a congenital reflux nephropathy.