A follow-up study of pre-natally detected primary vesico-ureteric reflux: a review of 61 patients

Abstract

Objective: To describe the pre- and post-natal characteristics of primary vesico-ureteric reflux (VUR) in a retrospective study of babies presenting with VUR suspected from pre-natal ultrasonography.

Patients and methods: Between 1984 and 1994. 61 children (41 boys and 20 girls) with primary VUR were followed for 2 years after the pre-natal detection of urinary tract anomalies. Patients with VUR secondary to infravesical obstruction and duplex systems were excluded. The mean age at ante-natal diagnosis was 28.4 weeks of gestation; in 37 the reflux was bilateral and 98 refluxing units were reviewed.

Results: According to the international classification of VUR, 8% were grade 1, 32% grade 2, 38% grade 3, 16% grade 4 and 6% grade 5. Twelve patients (22 refluxing units) underwent ureteric re-implantation. Six kidneys showed renal scars on isotope renography and two nephrectomies were carried out in patients < 2 years old: in 40 patients (64 renal units) the VUR resolved spontaneously. Of the latter, eight were grade 1, 20 grade 2, 27 grade 3 and nine grade 4: seven patients (10 refluxing units) are still being followed and awaiting a decision on treatment.

Conclusion: This study confirms the predominance of boys in those with ante-natally suspected VUR. The spontaneous resolution during the first 2 years of life was apparent in most cases, even in those with severe reflux (grade 3-5).