Analysis of the long‐term outcome of surgically corrected vesico‐ureteric reflux

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Abstract
Authors from Tel‐Aviv reviewed a group of patients who had VUR corrected in childhood, assessing their long‐term outcome. Even when patients were successfully treated during childhood they were still prone to recurrent UTI, renal scarring, hypertension and complications during pregnancy. They suggested that a protocol for long‐term follow‐up was required. PUJ obstruction is evaluated in two studies. The first of these, from Athens, presents the characteristic clinical and imaging findings in patients with obstruction by crossing renal vessels. In the second, the authors from Toronto describe their experience with the technique of dismembered laparoscopic pyeloplasty via a retroperitoneal approach. They gave a very balanced view about their early experience with this procedure, which will be helpful to the reader. They end by suggesting that modifications in the method used for the anastomosis were required. OBJECTIVE: To review patients who had vesico‐ureteric reflux corrected surgically by ureteric reimplantation during childhood, and thus assess their long‐term outcome.PATIENTS AND 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.