NATURAL-HISTORY OF VESICOURETERAL REFLUX IN SIBLINGS

The authors reviewed the records and radionucleotide cystograms of 76 girls and 32 boys 2 weeks to 103 months old (mean 21 months) with vesi coureteral reflux detected as a result of the sibling-screening progra m. The patients had no history suggestive of urinary tract infections and were asymptomatic at the time of study. Reflux was graded as mild with tracer in the ureter only; moderate when tracer refluxed into the renal pelvis, which may have appeared minimally dilatated; and severe when the tracer refluxed into a grossly dilatated renal pelvis. Patie nts were initially medically managed and had yearly cystograms. At the time of diagnosis, reflux was unilateral in 52 patients and bilateral in 56. it was graded as mild in 13 children, moderate in 86, and seve re in 9. Follow-up cystograms were performed 7 to 59 months after diag nosis. With a mean follow-up of 18.5 months, the reflux resolved in 52 .8% of the patients. The yearly rate of resolution was 28%. Antireflux surgery was performed in 8, because of increasingly greater reflux in 5, urinary tract infections while receiving antibiotics in 2, and per sistent reflux after age 8 in 1. Of note is the fact that in the child ren whose reflux resolved, unilateral reflux resolved more rapidly tha n bilateral reflux (mean of 15 vs 23 months, respectively). Median tim e to resolution for mild reflux was 12 months compared with 27 months for moderate and 23 months for severe reflux. Notable also is the fact that 13 children showed apparent worsening of reflux as demonstrated by increasing grade of reflux or conversion of unilateral to bilateral reflux. These results do not differ from the course of reflux seen in children with urinary tract infections.