5-YEAR STUDY OF MEDICAL OR SURGICAL-TREATMENT IN CHILDREN WITH SEVEREVESICOURETERAL REFLUX DIMERCAPTOSUCCINIC ACID FINDINGS

The results of serial dimercaptosuccinic acid (DMSA) imaging over 5 ye ars are reported in 287 children with severe vesico-ureteral reflux en tered into the European Branch of the International Reflux Study in Ch ildren. The children were randomly allocated to medical (n = 147) or s urgical (n = 140) management and DMSA studies were performed during th e follow up period at least 6 months after any urinary tract infection . Abnormal images were classified into four types: (1) large polar hyp odensity with normal renal outline; (2) peripheral photon deficient de fect(s) in a non-deformed kidney; (3) small renal image with normal co ntour; and (4) peripheral defect(s) with resultant irregularity of the renal outline. The DMSA findings were abnormal at entry in 235 (82%) with no difference in incidence or severity between the two treatment groups. During follow up, deterioration was observed in 25 medically a nd 23 surgically treated patients and comprised image deterioration al one in 17, image deterioration with corresponding reduction in differe ntial function in 16 and reduction in relative function without image change in 15, with similar distribution between the two treatment grou ps. Deterioration was more frequent in children entering the study und er the age of 2 years and in these with grade IV rather than grade III reflux. These findings, showing no difference in outcome between chil dren managed surgically or medically, are consistent with the radiolog ical results already published. Conclusion In the International Reflux Study the DMSA scintigraphic data showed no difference in outcome bet ween children managed surgically or medically.