Analysis of the long-term outcome of surgically corrected vesico-ureteric reflux.
OBJECTIVE
To review patients who had vesico-ureteric reflux corrected surgically by ureteric reimplantation during childhood, and thus assess their long-term outcome.


METHODS
Between 1970 and 1979, 322 children underwent ureteric reimplantation; 100 (79 women and 21 men) were re-assessed and the long-term results evaluated using a questionnaire, a review of the patients' current medical records and an appointment in the outpatient clinic. The evaluation focused on the frequency of late urinary tract infections (UTIs), current renal function tests, related complications during pregnancy and the incidence of hypertension at least 20 years after surgery.


RESULTS
Of the study group, 51% (66% of men and 47% of women) had no long-term urological complications. The incidence of UTIs was 43% in women and 24% in men, and of pyelonephritis 27% and 9.5%, respectively. Hypertension was detected in 6% of the patients during assessment. There were new renal scars, despite surgery, in 20% of the patients. Forty-seven women had been pregnant, 28% reporting UTIs during pregnancy. In 7% of 94 pregnancies the women also had pre-eclampsia and two women had transient gestational ureteric obstruction which required drainage. Renal functional tests were worse in one man and one woman who developed end-stage renal disease and had a renal transplant.


CONCLUSIONS
This series shows that even patients who were treated successfully by ureteric reimplantation during childhood are prone to recurrent UTIs, progressive renal scarring, hypertension and complications during pregnancy. There is a need to establish a protocol for the long-term follow-up of such patients.
Mor
Y
Y
Department of Urology, The Chaim-Sheba Medical Center, Affiliated to Tel Aviv University, Israel. morna@qbi.co.il
Leibovitch
I
I
Zalts
R
R
Lotan
D
D
Jonas
P
P
Ramon
J
J
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007676:Kidney Failure, Chronic / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011225:Pre-Eclampsia / Q000209:etiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000209:etiology; D012008:Recurrence; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000209:etiology; D014552:Urinary Tract Infections / Q000209:etiology; D014718:Vesico-Ureteral Reflux / Q000601:surgery*