Influence of gender on the outcome of endoscopic correction in vesicoureteric reflux

PURPOSE

To assess the influence of gender on the manifestations of vesicoureteric reflux(VUR) and outcomes of endoscopic correction(EC)

MATERIALS AND METHODS

Children who underwent EC were included in this prospective study. Indications for EC included children with dilating reflux(Grade 3+)and symptomatic children with VUR irrespective of grade.

RESULTS

Sixty children with VUR were identified, 27 males and 33 females. A quarter had hydronephrosis on antenatal scans, of which 80% were male. Urine infections (UTI) occured in 83% of the cases, with 97% of girls and 67% of boys being affected. The symptoms in girls were predominantly lower tract related in terms of dysuria, urgency, offensive urine and incontinence. Boys presented with febrile UTI. There was no significant difference in VUR severity between boys and girls, nor was VUR significantly worse with respect to laterality. EC with Deflux was carried out at a mean age of 2.8 years in boys and 6.4 years in girls. Mean time to follow-up was 5 and 7 months in girls and boys respectively. In patients with follow-up data available, 81% of refluxing units were cured in females after one Deflux treatment compared to 53% in males. After two treatments, cure rate increased in females only, to 92%. In bilateral cases, where both refluxing units were treated, cure rate was 85% in females after one treatment rising to 100% after two. In boys, cure rate was 31% after one treatment. In girls who were largely symptomatic, 84% were clinically improved on follow up and had no UTI after one Deflux treatment.In boys with UTI preoperatively, 91% had clinically improved.

CONCLUSIONS

VUR is a different problem in boys compared to girls. The algorithm of VUR is changing. EC should have an essential role in the management options along with conservative management and invasive surgery. Girls with VUR respond significantly better than boys to EC.

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