Low incidence of new renal scars after ureteral reimplantation for vesicoureteral reflux in children: A prospective study

Purpose: The major aim of treating vesicoureteral reflux in children is the prevention of renal scars. Dimercapto-succinic acid (DMSA) is the modality of choice for detecting renal scars. We documented the incidence of new re nal scarring and measured changes in differential renal function after uret eral reimplantation using DMSA studies. Materials and Methods: We evaluated 45 boys and 98 girls with a median age of 2 years who had vesicoureteral reflux and underwent ureteral reimplantat ion. DMSA scans were done preoperatively and at a median of 3.4 years posto peratively. Maximal reflux grade was III in 84 children (59%), IV in 27 (19 %) and V in 6 (4%). Results: Preoperatively DMSA studies showed scarred or contracted kidneys i n 106 of the 143 patients (74%). After reimplantation mean change in differ ential function was 2.5%. New scars developed in 3 children (2%). We noted greater than 6% decrease in relative differential function without new scar ring in 7 cases (5%). Conclusions: The incidence of new renal scars in our study using DMSA was l ower than that in previous series using excretory urography and imaging. Su rgical correction of vesicoureteral reflux may offer better protection of k idneys in childhood than previously believed.