The vesicoureteral reflux dysplasia syndrome in patients with posterior urethral valves.

摘要

PURPOSE: We retrospectively reviewed outcomes in children followed for posterior urethral valves and the vesicoureteral reflux dysplasia (VURD) syndrome. MATERIALS AND METHODS: Of 65 patients with posterior urethral valves 13 fulfilled the criteria for the VURD syndrome. Patients were assessed with diethylenetriamine pentaacetic acid and dimercapto-succinic acid scans at followup to evaluate stability of renal function, presence of renal scarring and drainage of the contralateral kidney. Student's t test and the chi-square test were used for statistical analysis, with p < or = 0.05 considered significant. RESULTS: Based on the dimercapto-succinic acid scan reports, patients were classified into group 1 (6 patients), in which the contralateral kidney had no evidence of scarring, and group 2 (7 patients), in which the contralateral kidney had evidence of scars. Patients in group 1 had no breakthrough urinary tract infections or history of urinary incontinence. There was no dilatation of the contralateralupper urinary tract, and 5 of 6 patients had prompt ureteral drainage on scans. They also attained a long-term serum creatinine of 0.6 +/- 0.0 mg/dl. Patients in group 2 had a significant incidence of breakthrough urinary tract infections (p < or = 0.03) and diurnal incontinence (p < or = 0.01). Hydroureteronephrosis and slow drainage were seen in 6 of 7 patients on scans. The long-term mean serum creatinine attained in this group was 0.9 +/- 0.3 mg/dl. CONCLUSIONS: About half of the patients with the VURD syndrome had renal scarring in the contralateral kidney. These patients had evidence of hydroureteronephrosis, slow drainage of the ureter in association with breakthrough urinary tract infections and diurnal incontinence. Although serum creatinine in patients with the VURD syndrome and renal scarring in the contralateral kidney was not statistically different from that in children with a normal contralateral kidney in the short term, in the long term the deleterious effects of renal scarring, viz hypertension, proteinuria and renal failure, are likely to manifest. The presence of the VURD syndrome may not always be as good a prognostic indicator as believed previously.