SURGICAL-TREATMENT OF VESICOURETERAL REFLUX IN INFANTS UNDER 3 MONTHSOF AGE

Purpose: Surgical treatment for vesicoureteral reflux (VUR) is controv ersial in infants, especially small infants because of technical diffi culty and higher rate of spontaneous resolution. However, in some cond itions, such as high-grade reflux, breakthrough infection, or severe r enal scarring, early operation may be justified. This study is to eval uate the results of ureteral reimplantation in infants with VUR under 3 months of age. Methods: From January 1993 to July 1997, 13 boys and five girls (24 ureters) under 3 months of age (range, 18 days to 3 mon ths; mean age, 2 months) received ureteral reimplantation for VUR. The initial symptoms were urinary tract infection (UTI) in 16 infants, hy dronephrosis found by prenatal ultrasound scan in one, and early postn atal screening ultrasound scan in one. The indications for 24 ureter r eimplantations were high-grade reflux (grade V, n = 7), breakthrough i nfection under medical treatment (n = 5), and severe renal scarring (n = 8) and contralateral low-grade refluxing ureters (n = 4). All patie nts had Glenn-Anderson's or Cohen's ureteral reimplantation. Ureteral stents were required in six ureters. All patients had renal sonogram 1 month after operation to rule out ureteral obstruction. Fifteen patie nts had voiding cystourethrogram (VCUG) after operation. Renal growth was evaluated in 15 patients (20 reflux renal units) using serial ultr asound or differential perfusion renal scan. The operative time, use o f ureteral stent, complication rate, hospital stay, and time needed fo r clearing urine, were compared with those of 115 counterpart patients at age over 3 months. Data were analyzed using chi(2) test or ttest. Results: All patients, except one, were free of UTI during the follow- up of 6 months to 5 years. In fifteen infants who had postoperative VC UG, 14 were free of reflux, and one had persistent lower-grade VUR. On e patient had transient ureteral obstruction that resolved spontaneous ly. One patient had postoperative ileus for 2 weeks. Renal growth of 2 0 reflux renal units was similar to that of the contralateral nonreflu x kidneys. The only significant difference when compared with the pati ents over 3 months of age, was the higher incidence of ureteral stenti ng (25% v 4.2%, P <.01). Conclusions: Ureteral reimplantation should b e performed in infants under 3 months of age when it is indicated. Cop yright (C) 1998 by W.B. Saunders Company.