Al Qahtani Wadha, Sarhan Osama, Al Otay Abdulhakim, El Helaly Ahmed, Al Kawai Fouad
Urology, King Fahad Specialist Hospital, Dammam, SAU.
Urology, Mansoura Urology and Nephrology Center, Mansoura, EGY.
Cureus. 2020 Dec 25;12(12):e12266. doi: 10.7759/cureus.12266.
Objective Vesicoureteral reflux (VUR) is a common finding in the pediatric population with the risk of repeated infections and renal damage. There is little is known about the natural history of primary bilateral high-grade reflux. Herein we present our experience in the management of primary high-grade bilateral VUR and the long-term outcome of renal function in this specific group of patients. Materials and methods We retrospectively evaluated all patients with congenital bilateral VUR between 2006 and 2014. Records were reviewed for patient age at diagnosis, antenatal history, clinical presentation, the grade of VUR on voiding cystourethrogram (VCUG), presence of scars on dimercaptosuccinic acid (DMSA) scan, indications for surgical intervention, and surgical approaches. Clinical and radiological outcomes of this subgroup of patients were assessed. Results A total of 67 patients with bilateral VUR were identified, of whom 31 (20 boys and 11 girls) had primary high-grade (grade IV and V) bilateral VUR. The mean age at diagnosis was seven months. DMSA scans showed renal scars in 19 patients (61%) and eight of them were bilateral. Surgical intervention was necessary for 81% of patients with a success rate of 58% after endoscopic correction and 100% after reimplantation. Chronic kidney disease (CKD) developed in 13 patients (42%) after a mean follow-up of eight years. Conclusions Primary bilateral high-grade VUR carries a high rate of surgical intervention. The endoscopic correction has an acceptable success rate and efficient long-term outcome. Nevertheless, a significant proportion of patients progresses to CKD even after VUR management.
目的 膀胱输尿管反流（VUR）在儿科人群中很常见，存在反复感染和肾损伤的风险。关于原发性双侧重度反流的自然病程知之甚少。在此，我们介绍我们在原发性重度双侧VUR治疗方面的经验以及该特定患者群体的肾功能长期预后。材料与方法 我们回顾性评估了2006年至2014年间所有先天性双侧VUR患者。查阅记录以了解诊断时的患者年龄、产前病史、临床表现、排尿性膀胱尿道造影（VCUG）上的VUR分级、二巯基丁二酸（DMSA）扫描上的瘢痕情况、手术干预指征和手术方法。评估该亚组患者的临床和影像学结局。结果 共识别出67例双侧VUR患者，其中31例（20例男孩和11例女孩）患有原发性重度（IV级和V级）双侧VUR。诊断时的平均年龄为7个月。DMSA扫描显示19例患者（61%）有肾瘢痕，其中8例为双侧。81%的患者需要手术干预，内镜矫正后的成功率为58%，再植术后为100%。平均随访8年后，13例患者（42%）发生慢性肾脏病（CKD）。结论 原发性双侧重度VUR的手术干预率很高。内镜矫正具有可接受的成功率和有效的长期结局。然而，即使在VUR治疗后，仍有相当比例的患者进展为CKD。
