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Direct vesicoureteral scintigraphy: quantifying early outcome predictors in children with primary reflux
P D Mozley1, S Heyman, J W Duckett
1Division of Nuclear Medicine, Children's Hospital of Philadelphia, University of Pennsylvania.
Insights
Predicting surgical outcomes in children with primary vesicoureteral reflux is possible. Larger bladder volumes at reflux onset and smaller reflux volumes indicate a lower risk of surgery with medical management.
Area of Science:
- Pediatric Urology
- Nephrology
- Medical Imaging
Background:
- Primary vesicoureteral reflux (VUR) is common in children.
- Medical management is a primary treatment approach.
- Predicting surgical outcomes is crucial for treatment planning.
Purpose of the Study:
- To identify predictors of outcome in children with primary VUR managed medically.
- To assess the utility of quantitative direct vesicoureteral scintigraphy (DVS) in predicting surgical intervention.
Main Methods:
- 133 children with primary VUR were studied for 7.1 years.
- Direct vesicoureteral scintigraphy (DVS) measured reflux onset volume and reflux volume.
- Outcomes were defined as spontaneous resolution or need for surgery.
Main Results:
- Medical management failed in 35% of patients.
- Reflux beginning at >60% bladder capacity significantly reduced surgery risk.
- Reflux volume <2% of bladder capacity also significantly reduced surgery risk (p < 0.001).
Conclusions:
- Quantitative DVS provides valuable prognostic information.
- Bladder volume at reflux onset and reflux volume are key predictors.
- These DVS metrics aid in managing medically treated children with VUR.
Unlabelled:
This study quantifies some of the outcome predictors in a group of children with primary vesicoureteral reflux who were initially managed medically.
Methods:
We studied 133 patients with primary reflux for 7.1 +/- 2.2 yr. Direct vesicoureteral scintigraphy (DVS) was used to prospectively measure the absolute bladder volume at which reflux began and the maximum volume of urine refluxed into the ureters during the filling and voiding phases of their first two DVS studies. Findings were related to outcome as defined by spontaneous resolution or the eventual need for reconstructive surgery.
Results:
Medical management eventually failed in 35% of this sample. Patients who did not begin to reflux until their bladders had been filled to more than 60% total bladder capacity had a substantially smaller risk of surgery than those who began to reflux at smaller bladder volumes. Patients who refluxed a volume of urine back into their ureters that was less than about 2% of their total bladder capacity had a substantially smaller risk of surgery than those who refluxed more than 2%. The difference between groups was significant for both DVS variables (p < 0.001).
Conclusion:
Quantitative DVS contributes to the assessment of prognosis in children with vesicoureteral reflux who are managed medically.