Low incidence of new renal scars after ureteral reimplantation for vesicoureteral reflux in children: a prospective study.
OBJECTIVE
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 renal scarring and measured changes in differential renal function after ureteral reimplantation using DMSA studies.


METHODS
We evaluated 45 boys and 98 girls with a median age of 2 years who had vesicoureteral reflux and underwent ureteral reimplantation. DMSA scans were done preoperatively and at a median of 3.4 years postoperatively. 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 in 106 of the 143 patients (74%). After reimplantation mean change in differential function was 2.5%. New scars developed in 3 children (2%). We noted greater than 6% decrease in relative differential function without new scarring in 7 cases (5%).


CONCLUSIONS
The incidence of new renal scars in our study using DMSA was lower than that in previous series using excretory urography and imaging. Surgical correction of vesicoureteral reflux may offer better protection of kidneys in childhood than previously believed.
Webster
R I
RI
Departments of Urology and Nephrology, Sydney Children's Hospital, Prince of Wales Hospital, Randwick, New South Wales, Australia.
Smith
G
G
Farnsworth
R H
RH
Rossleigh
M A
MA
Rosenberg
A R
AR
Kainer
G
G
D000293:Adolescent; D002614:Chelating Agents; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012092:Replantation; D004113:Succimer; D014513:Ureter / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging / Q000601:surgery*
D002614:Chelating Agents; D004113:Succimer