Predictive factors for the development of contralateral reflux in children with unilateral reflux treated conservatively

PURPOSE

Children with unilateral vesicoureteral reflux (UVUR) treated conservatively may develop new contralateral reflux (NCLR). This study evaluates the risk factors to NCLR development; the time to NCLR diagnosis and evaluates the outcome of patients with NCLR.

MATERIAL AND METHODS

167 children with UVUR in the first VCUG were evaluated retrospectively. In 14 patients reflux was diagnosed by radioisotope and it was not graded. VCUG reflux grades were: I-21, II-70, III-48, IV-13 and V-1. All children had 2 VCUGs performed, 84 had 3, 35 had 4, 18 had 5, 9 had 6 e 3 had 7 VCUGs.

RESULTS

NCLR was diagnosed in 33 (20%) patients. The gender, age, side of reflux and the presence of LUTD were not predictive of NCLR. Only previous high grade reflux was a risk factor of NCLR development (p<0,05). Of 62 patients with high grade (III-IV) reflux, 42 developed NCLR. Of 91 patients with grade I-II reflux, 11 developed NCLR. Reflux spontaneous resolution was less frequent in children with NCLR (p=0,017). NRVUC was detected in the 2nd VCUG in 30 cases, in the 3rd in 2 and in the 4th in 1 patient. The NCLR grades were I in 4 children, II in 18, III in 9 and IV in 1.

CONCLUSIONS

NCLR occurred in 20% of children with UVUR. Around 90% of NCLR was detected in the 2nd VCUG .The main risk factor for NCLR was an initial high grade of reflux. Children with NCLR had a worse rate of spontaneous VUR resolution than patients that remained with UVUR.

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