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Evolution of Vesicoureteral Reflux in Patients With Myelomeningocele in a Proactive Follow-Up Protocol

O E Blain1, J Ruiz1, C Sager1

  • 1Department of Urology, Hospital "Prof. Dr. Juan P. Garrahan", Pichincha 1890, C1245 CABA, Buenos Aires, Argentina.

Journal of Pediatric Surgery
|August 10, 2025
PubMed
Abstract

Insights

The incidence of vesicoureteral reflux (VUR) in myelomeningocele (MMC) patients is 16%. A proactive approach led to a 65% VUR resolution rate within two years, though most patients still develop chronic kidney disease (CKD).

Area of Science:

  • Pediatric Urology
  • Nephrology
  • Developmental Biology

Background:

  • Myelomeningocele (MMC) is associated with a significant incidence of vesicoureteral reflux (VUR), ranging from 17% to 26.3% in the first six months of life.
  • A proactive management strategy for VUR in MMC patients has shown potential for resolution rates between 30% and 50% over 2-3 years.

Purpose of the Study:

  • To determine the incidence of VUR in pediatric patients with MMC.
  • To identify factors associated with VUR occurrence in this population.
  • To analyze the progression of VUR and chronic kidney disease (CKD) under a proactive management protocol.

Main Methods:

  • Retrospective observational cohort study (Level of Evidence: III) of newborns with MMC managed proactively between 2015 and 2020.
  • Patients were categorized based on the presence or absence of VUR identified via videourodynamic study (VUDS) at a mean age of 6 months.
  • Demographic and nephro-urological variables were compared between initial diagnosis and the last follow-up year.

Main Results:

  • The overall incidence of VUR in pediatric MMC patients was 16% (14 out of 68 analyzed).
  • Low-grade VUR was predominant (78.6%), with a VUR resolution rate of 64.3% within a median of 22 months.
  • Surgical closure of the MMC defect after the first 24 hours of life was significantly associated with VUR (p < 0.001); 57% of patients developed CKD.

Conclusions:

  • The incidence of VUR in pediatric MMC patients is 16%, with a high resolution rate (65% within 2 years) observed under a proactive management protocol.
  • Despite VUR resolution, the majority of these patients are at high risk for developing chronic kidney disease (CKD).
  • Early surgical intervention timing may influence VUR development in MMC patients.
Keywords:
Chronic kidney diseaseMyelomeningoceleProactive treatmentUrinary tract infectionVesicoureteral reflux

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