Unilateral vesicoureteral reflux: association with protected renal function in patients with posterior urethral...

The prognosis in patients with posterior urethral valves (PUV) is related to the degree of renal insufficiency. Urinary ascites or urinoma, congenital bladder diverticula, or severe unilateral vesicoureteral reflux has been associated with protected renal function. We present clinical and imaging findings in eight patients with PUV and unilateral reflux who have preserved renal function. Initial and follow-up sonography, voiding cystourethrography, and nuclear imaging were reviewed and compared with long-term serum creatinine levels.

All eight patients had normal renal function on long-term follow-up, suggesting that unilateral reflux, which occurs in as many as 35% of boys with PUV, is associated with protected renal function. Although early nephrectomy of the refluxing unit has been advocated for patients with PUV and unilateral reflux into a dysplastic kidney (the vesicoureteral reflux and renal dysplasia syndrome), we found that significant renal function may be present in the refluxing kidney and that function may even increase with time. Most of these patients did well without nephrectomy. Therefore, a sufficient interval should elapse before nephrectomy is considered in these patients.