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Primary Bilateral High-Grade Vesicoureteral Reflux in Children: Management Perspective
Wadha Al Qahtani1, Osama Sarhan2, Abdulhakim Al Otay3
1Urology, King Fahad Specialist Hospital, Dammam, SAU.
Cureus
|February 1, 2021
Summary
Primary high-grade bilateral vesicoureteral reflux (VUR) often requires surgery. While endoscopic correction is successful, many children still develop chronic kidney disease (CKD).
Area of Science:
- Pediatric Urology
- Nephrology
Background:
- Vesicoureteral reflux (VUR) is common in children, risking infections and kidney damage.
- The natural history of primary high-grade bilateral VUR is not well understood.
Purpose of the Study:
- To evaluate the management and long-term renal function outcomes in children with primary high-grade bilateral VUR.
Main Methods:
- Retrospective review of 67 patients with congenital bilateral VUR (2006-2014).
- Analysis included diagnosis age, VUR grade, renal scarring (DMSA scan), surgical interventions, and outcomes.
- Focused on 31 patients with primary high-grade (IV-V) bilateral VUR.
Main Results:
- 31 patients (mean age 7 months) had primary high-grade bilateral VUR.
- Renal scars were present in 61% of patients (8 bilateral).
- 81% required surgery; endoscopic correction success was 58%, reimplantation was 100%.
- 42% developed chronic kidney disease (CKD) after a mean 8-year follow-up.
Conclusions:
- Primary high-grade bilateral VUR necessitates frequent surgical intervention.
- Endoscopic correction offers acceptable success and long-term outcomes.
- A significant percentage of patients progress to CKD despite VUR management.
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