Cs. Liu et al., Contralateral reflux after unilateral ureteral reimplantation-preexistent rather than new-onset reflux, J PED SURG, 34(11), 1999, pp. 1661-1664
Purpose: The authors studied the preoperative Technetium 99m-dimercaptosucc
inic acid renal scan (DMSA) of patients undergoing unilateral vesicouretera
l antireflux surgery to compare the amount of renal scarring between the re
fluxing and the contralateral renal units. They sought to determine whether
postoperative contralateral vesicoureteral reflux was preexistent or new o
nset.
Methods: Sixty-eight patients who underwent unilateral vesicoureteral antir
eflux surgery and had preoperative DMSA a nd postoperative voiding cystoure
thrography (VCUG) examinations were studied. Preoperative DMSA results were
analyzed to determine the amount of renal scarring in each kidney.
Results: Sixty-four (94.1%) ipsilateral refluxing renal units had renal sca
rs. Of the 68 contralateral renal units, scars were noted in 28 (41.2%). Th
e rate of nonscar was 4 of 68 (5.9%) in reflux kidneys, which was significa
ntly lower than 40 of 64 (62.5%, excluding 4 with a history of resolved ref
lux) in nonreflux kidneys (P<.001). Of 40 contralateral nonscarred kidneys,
1 of 40 (2.5%) had subsequent reflux, which was significantly lower than 5
of 28 (17.9%) of scarred kidneys (P<.005). Six patients (8.8%) had contral
ateral reflux, and 1 of them had a history of resolved reflux. Of the 6 con
tralateral kidneys with severe scarring involving 3 poles or contracted, 4
of 6 (66.7%) had subsequent reflux.
Conclusions: Scar in the contralateral kidney seen on DMSA scan seems to pr
edict contralateral reflux after unilateral antireflux surgery. The contral
ateral reflux may be preexistent. Postoperative VCUG should be performed ro
utinely for patients who have contralateral renal scars. In patients with a
history of contralateral reflux or severe contralateral renal scar, simult
aneous contralateral ureteral reimplantation should be considered. Copyrigh
t (C) 1999 by W.B. Saunders Company.