Surgical correction of vesicoureteral reflux: 5-year follow-up with 99Tcm-DMSA scintigraphy.
OBJECTIVE
To evaluate kidney function before and after surgical correction of vesicoureteral reflux. The long-term effect was measured with quantitative nephro-scintigraphy using 99Tcm labelled dimercaptosuccinic acid (99Tcm-DMSA).


METHODS
Forty-five children with a history of urinary tract infections due to vesicoureteral reflux (VUR) were studied. VUR grade was determined with contrast voiding cystourethrography. Planar scintigraphy was performed with 99Tcm-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 eight of 76 treated renal units. Kidney uptake at 5-year follow-up was unchanged in the majority of children, indicating preservation of renal function found 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 from unity (P<0.05). Empirical kidney-depth correction techniques were compared. The scintigraphic pattern worsened in six kidneys, indicative of increased scarring in a minority of children.


CONCLUSIONS
Planar nephro-scintigraphy with 99Tcm-DMSA was well tolerated in our paediatric population, and appeared appropriate to evaluate kidney function in time. After surgical correction of VUR, the baseline function was maintained in 94% of kidneys.
Department of Molecular and Medical Pharmacology, UCLA School of Medicine, Los Angeles, CA 90095, USA. cschiepers@mednet.ucla.edu
C
C
Schiepers
L
L
Mesotten
W
W
Proesmans
R
R
Vereecken
A
A
Verbruggen
M
M
de Roo
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007668:Kidney / Q000000981:diagnostic imaging / Q000378:metabolism; D007677:Kidney Function Tests; D008297:Male; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D014552:Urinary Tract Infections / Q000000981:diagnostic imaging; D014563:Urodynamics / Q000502:physiology; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging* / Q000601:surgery*
D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid