20-YEAR FOLLOW-UP OF 158 YOUNG-ADULTS SURGICALLY TREATED FOR VESICORENAL REFLUX IN CHILDHOOD - THE ONGOING RISK OF URINARY-TRACT INFECTION

A total of 158 out of 189 patients (160 male, 29 female), who were fol lowed up in 1985, an average of 10.8 years after reflux operation, wer e contacted again in 1995. At this time, the median age of the patient s was 26 years (15.7-38.8 years) and the period of observation 20.3 ye ars (13.4-26 years). The objective of the investigation was to record urinary tract infections and arterial hypertension during the long-ter m postoperative course. In 82% of the patients, febrile and in 18% afe brile symptomatic urinary tract infections had occurred preoperatively . In the first 10-year period after the operation, 46% continued to su ffer from symptomatic urinary tract infections as compared to 52% in t he second 10-year interval. In both periods, the incidence of febrile urinary tract infection was about 17%. Within the entire period of pos toperative observation, symptomatic urinary tract infections occurred in 66% of the patients (74% of the female patients). Symptomatic urina ry tract infections were observed in eight (17%) out of 46 pregnancies . The incidence of arterial hypertension (blood pressure > / = 140/ 90 mmHg) was 11.5% (median age 16.4 years) in patients with radiological ly demonstrated renal parenchymal scars at the first follow-up investi gation and 11.3% at the second follow-up investigation (median age 26 years). After successful surgical reflux correction, susceptibility to urinary tract infection continues for years in many girls and women. However primarily afebrile urinary tract infections occurr postoperati vely. Regular checks of blood pressure are necessary in reflux nephrop athy well into adulthood because of the increased risk of arterial hyp ertension. During pregnancy, patients require more intensive surveilla nce.