Surgical correction of vesicoureteral reflux: 5-year follow-up with Tc-99(m)-DMSA scintigraphy

Aim To evaluate kidney function before and after surgical correction of ves icoureteral reflux. The longterm effect was measured with quantitative neph ro-scintigraphy using Tc-99(m) labelled dimercaptosuccinic acid (Tc-99(m)-D MSA). Methods Forty-five children with a history of urinary tract infections due to vesicoureteral reflux (VUR) were studied. WR grade was determined with c ontrast voiding cystourethrography. Planar scintigraphy was performed with Tc-99(m)-DMSA and uptake measured as a percentage of injected dose. Kidney function was evaluated at baseline and 5 years after corrective surgery. Results Three months after surgery, persistent mild reflux was found in eig ht of 76 treated renal units. Kidney uptake at 5-year follow-up was unchang ed in the majority of children, indicating preservation of renal function f ound at baseline. The split renal function showed an excellent correlation (r = 0.99) between baseline and follow-up studies (regression slope 1.01). Percentage uptake had a regression slope of 0.89 significantly different fr om unity (P < 0.05). Empirical kidney-depth correction techniques were comp ared. The scintigraphic pattern worsened in six kidneys, indicative of incr eased scarring in a minority of children. Conclusion Planar nephro-scintigraphy with Tc-99(m)-DMSA was well tolerated in our paediatric population, and appeared appropriate to evaluate kidney function in time. After surgical correction of WR, the baseline function wa s maintained in 94% of kidneys. ((C) 2001 Lippincott Williams & Wilkins).