Vesicoureteral reflux in children. Experience in riyadh, saudi arabia

There are a few reports about the size of the problem of vesicoureteral reflux (VUR) in developing countries. We attempted in our study to assess the experience of this problem in children in a tertiary care medical center in the period between June 1983 till June 1993. VUR was diagnosed in 24 patients, of whom 71% were boys. The mean age of the patients was 36.5 months; seven (29%) of them were below one year of age. The commonest presentation was urinary tract infection. E. coli was the most common organism and was resistant to the first chpice chemoprophylaxis in 50% of cases. Urine culture was also positive in 37.5% of children who were grossly asymptomatic. Ultrasound study failed to detect VUR in 25% of cases. There were eleven patients with mild to moderate reflux (grades I, II, III) of whom 9% required ureter reimplantation by open surgery. Eleven patients had severe reflux (grades IV,V) of whom 72% required the same procedure. Post-operatively, of the nine patients who had reimplantation, seven (77.5%) had successful surgery and maintained normal renal function after a mean duration of follow up of 30 months (range from 6 to 84 months), one patient developed end-stage renal disease, and one patient was lost to follow-up. We conclude that VUR is not uncommon in early childhood. Early referral of severe cases for surgical reimplantation is recommended.