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The natural history of reflux in the lower pole of duplicated collecting systems: a controlled study
1Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Insights
Reflux into the lower pole of a duplex kidney in children does not require early surgery. Non-operative management showed similar outcomes and renal scarring rates compared to reflux in single systems.
Area of Science:
- Pediatric Urology
- Nephrology
Background:
- Vesicoureteral reflux (VUR) is common in children.
- Duplicated collecting systems are a frequent anomaly.
- Reflux into duplex systems raises concerns for renal damage.
Purpose of the Study:
- To compare non-operative outcomes of VUR in duplex systems versus single systems.
- To determine if duplex system reflux necessitates early surgical intervention.
Main Methods:
- Retrospective comparison of 32 children with duplex system reflux to a control group.
- Non-operative management for 1-5 years.
- Assessment of reflux outcome and new renal scarring.
Main Results:
- No significant difference in reflux outcome between duplex and single systems.
- Similar incidence of new renal scarring in both groups.
- Non-operative management was effective for both conditions.
Conclusions:
- Reflux into the lower pole of a duplex kidney is not an independent indication for early surgery.
- Conservative management is a viable option for these pediatric patients.
Abstract:
Thirty two children with reflux into the lower pole of duplicated collecting systems, followed non-operatively for one to five years, were compared to a carefully selected control group of similar children who had reflux into a single collecting system. There were no significant differences between the two groups, either in the outcome of reflux or in the incidence of new renal scars. We conclude that reflux into the lower pole of a duplex kidney does not in itself constitute an indication for early surgical treatment.