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Duplex reflux: a study of 105 children
P H Lee1, D A Diamond, P G Duffy
1Division of Urology, Hospitals for Sick Children, London, England.
Insights
Vesicoureteral reflux in duplicated systems shows similar spontaneous resolution rates to single systems. Mild to moderate reflux (grades I and II) has an 85% resolution, while grade III has 36%.
Area of Science:
- Pediatric Urology
- Nephrology
- Medical Research
Background:
- Vesicoureteral reflux (VUR) is a condition where urine flows backward from the bladder to the kidneys.
- Completely duplicated collecting systems are a congenital anomaly that can be associated with VUR.
- Understanding VUR resolution in these complex anatomies is crucial for effective management.
Purpose of the Study:
- To retrospectively analyze the outcomes of children with VUR in completely duplicated collecting systems.
- To compare spontaneous reflux resolution rates in duplicated systems with those in single systems.
- To evaluate the effectiveness of surgical versus nonoperative management strategies.
Main Methods:
- Retrospective study of 105 children diagnosed with VUR and completely duplicated collecting systems.
- Analysis of treatment approaches: surgical (ablative or reimplantation) versus nonoperative management.
- Long-term follow-up (up to 11 years) to assess spontaneous resolution rates based on reflux grade and moiety involvement.
Main Results:
- 64% of children underwent surgical intervention, while 36% were managed nonoperatively.
- Spontaneous resolution rates were 85% for grades I and II VUR and 36% for grade III VUR.
- Reflux primarily involved the lower pole moiety (89%) or both moieties (11%).
Conclusions:
- Spontaneous resolution of mild to moderate VUR in duplicated collecting systems mirrors rates seen in single systems.
- Nonoperative management appears viable for selected cases, particularly with lower-grade reflux.
- Further research may refine treatment guidelines for VUR in complex pediatric urinary tract anomalies.
Abstract:
A series of 105 children with vesicoureteral reflux into completely duplicated collecting systems was studied retrospectively. Of the children 64% were treated surgically, with two-thirds undergoing an ablative procedure and one-third undergoing common sheath ureteral reimplantation. The remaining 36% of the children were managed nonoperatively and followed for up to 11 years. Among these cases 89% of the kidneys had reflux into the lower pole moiety only and 11% had reflux into the upper and lower pole moieties. The spontaneous rates of reflux resolution were 85% for grades I and II, and 36% for grade III reflux during a median observation period of 40 months. These figures suggest that the spontaneous resolution of mild to moderate reflux into completely duplicated collecting systems is similar to that of identical degrees of single system reflux during a comparable observational period.