Primary vesico-ureteral reflux in children: study of 100 cases.

In this study, the authors have reported 100 cases of primary vesico-ureter al reflux (VUR) which occurred over a 7-year period. Patient age at present ation ranged from 1 month to 13 years, with a mean age of 3 years and 5 mon ths. Overall, a higher rate of reflux was observed in the female population (63%) which was particularly evident after the age of 3 years, but with a male predominance during the first 12 months of life. In the majority of ca ses, the diagnosis of VUR was made following diagnosis and investigation of urinary infection (UI). A high level of UI was the most frequent sign of V UR (87% of cases), while in 6% of cases this disorder was diagnosed during the investigation of an uropathy which was found to be complex in all subje cts. An analysis of 143 ureteral reflux units (URU) showed that VUR was pat hological only in 17% of cases, and that the reflux grade was I, II, III an d IV in 47.4, 28.14, 11.11 and 2.34% of cases respectively. DMSA scintigrap hy in 38 patients showed signs of nephropathy in 24 cases, i.e., 14 scars a nd a decrease in kidney size ;in 9 cases, and an absence of fixation for on e grade IV reflux. Forty subjects with 56 reflux units (34 grade I, II and 22 grade Ill, IV) were treated by antibiotic prophylaxis, with a positive o utcome in 85% of cases in children under 2 years of age, compared to 40% fo r children aged over 2 years. Only 7 patients were treated by teflon endosc opic injection, and in one case a further injection was required; 21 patien ts with 30 reflux units were treated by surgery at a mean age of 4 years. I n conclusion, VUR is a fairly common disorder, which is frequently detected via an IU; its potential gravity is associated with the risk of subsequent nephropathy. (C) 2000 Editions scientifiques et medicales Elsevier SAS.