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Prenatally diagnosed reflux: a follow-up study
A C Gordon1, D F Thomas, R J Arthur
1Department of Paediatric Surgery, General Infirmary, Leeds.
Insights
Prenatally detected vesicoureteric reflux (VUR) in infants often presents in males with high-grade reflux and associated abnormalities. While many cases resolve spontaneously or respond to chemoprophylaxis, some require surgical intervention.
Area of Science:
- Pediatric Urology
- Neonatal Medicine
- Medical Imaging
Background:
- Vesicoureteric reflux (VUR) is a common congenital anomaly in infants.
- Prenatal detection of VUR is typically based on fetal urinary tract dilatation.
- Understanding the characteristics and outcomes of prenatally detected VUR is crucial for management.
Purpose of the Study:
- To analyze the characteristics and outcomes of infants with prenatally detected VUR.
- To compare the demographic and clinical features of prenatally diagnosed VUR with those presenting clinically.
- To evaluate the effectiveness of chemoprophylaxis and the rate of spontaneous resolution.
Main Methods:
- Retrospective analysis of 25 infants with prenatally diagnosed VUR.
- Assessment of reflux grade, bilaterality, and coexistent congenital abnormalities.
- Monitoring of urinary tract infections, treatment outcomes (chemoprophylaxis, surgery), and spontaneous resolution rates.
Main Results:
- 84% of infants were male, contrasting with female predominance in clinically presenting VUR.
- VUR was predominantly high-grade (usually IV) and often bilateral (16/25 infants).
- 32% of infants had coexistent congenital abnormalities; 68% remained infection-free with chemoprophylaxis, while 20% required surgery.
Conclusions:
- Prenatally detected VUR in infants exhibits distinct characteristics, including a male predominance and higher grades of reflux.
- Chemoprophylaxis is effective in a majority of cases, but a significant proportion may still require surgical intervention.
- Spontaneous resolution occurs in a notable percentage of cases, highlighting the importance of long-term follow-up.
Abstract:
This report analyses the characteristics and outcome of 25 infants with vesicoureteric reflux detected prenatally on the basis of dilatation of the fetal urinary tract. Sixteen infants had bilateral reflux--a total of 41 refluxing units. The high proportion of males (84%) contrasts with clinically presenting reflux, which is dominated by females. Prenatally diagnosed reflux is generally of a higher grade--usually grade IV. Eight children (32%) had coexistent congenital abnormalities. Chemoprophylaxis was completely effective in 17 children (68%), who remained infection-free; 3 children (12%) had a single urinary infection and were managed conservatively whilst 5 (20%) experienced 2 or more infections and required reimplantation or vesicostomy. Spontaneous cessation of reflux was observed in 6 (35%) of 17 refluxing ureters reassessed after a mean interval of 2.1 years. The significance of isotope findings was sometimes difficult to assess but results in 30 refluxing units support the concept that focal renal scarring is usually a consequence of infected reflux in postnatal life.