Skip to main content

Advertisement

SpringerLink
Log in

Urinary tract anomalies associated with high grade primary vesicoureteral reflux

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Background

Few studies have evaluated the significance of associated urological anomalies in vesicoureteral reflux (VUR). The aim of our study was to determine the incidence of associated urological anomalies in patients with high grade VUR and to assess their impact on renal parenchymal scarring.

Methods

We retrospectively reviewed the hospital records of 1,765 consecutive cases diagnosed with high grade VUR (Grade III–V) at our hospital between 1998 and 2010. The diagnosis of VUR was made by a voiding cystourethrogram (VCUG). Renal scarring was evaluated by dimercapto-succinic acid (DMSA) scintigraphy and classified into three groups: mild (focal defects in uptake between 40 and 45%), moderate (uptake of renal radionuclide between 20 and 40%), and severe (shrunken kidney with relative uptake <20%). All associated urological anomalies were diagnosed by ultrasound or VCUG or DMSA scan.

Results

Associated urological anomalies were present in 229 (13%) children. There were 87 boys and 142 girls. Duplex kidney was the main associated anomaly occurring in 148 (64.6%) of the 229 patients. Other anomalies were: bladder diverticulum in 29, solitary kidney in 12, ureterocele in 13, hypospadiasis in 11, pelviureteric junction obstruction in 9, malrotated kidney in 3, horseshoe kidney in 2, crossed fused ectopia in 1 and renal cyst in 1. DMSA scan revealed renal scarring in 105 (47.7%) of the 220 children who had a DMSA scan. 75 (50.7%) children with duplex kidneys showed renal scarring.

Conclusion

Associated urological anomalies occur commonly in patients with high grade VUR. Our data shows that nearly half of the patients with VUR and associated urological anomalies have renal scarring. Early recognition and treatment of VUR patients with associated urological anomalies may decrease the risk of renal parenchymal damage.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Sargent MA (2000) What is the normal prevalence of vesicoureteral reflux? Pediatr Radiol 30(9):587–593

    Article  PubMed  CAS  Google Scholar 

  2. Smellie JM, Barratt TM, Chantler C et al (2001) Medical versus surgical treatment in children with severe bilateral vesicoureteric reflux and bilateral nephropathy: a randomised trial. Lancet 357(9265):1329–1333

    Article  PubMed  CAS  Google Scholar 

  3. Marra G, Oppezzo C, Ardissino G et al (2004) Severe vesicoureteral reflux and chronic renal failure: a condition peculiar to male gender? Data from the ItalKid Project. J Pediatr 144(5):677–681

    Article  PubMed  Google Scholar 

  4. Woolf AS (2000) A molecular and genetic view of human renal and urinary tract malformations. Kidney Int 58(2):500–512

    Article  PubMed  CAS  Google Scholar 

  5. Smellie JM, Prescod NP, Shaw PJ et al (1998) Childhood reflux and urinary infection: a follow-up of 10–41 years in 226 adults. Pediatr Nephrol 12(9):727–736

    Article  PubMed  CAS  Google Scholar 

  6. (1981) Medical versus surgical treatment of primary vesicoureteral reflux: report of the International Reflux Study Committee. Pediatrics 67(3):392–400

  7. Siomou E, Papadopoulou F, Kollios KD et al (2006) Duplex collecting system diagnosed during the first 6 years of life after a first urinary tract infection: a study of 63 children. J Urol 175(2):678–681 (discussion 681–672)

    Article  PubMed  Google Scholar 

  8. Molitierno JA Jr, Scherz HC, Kirsch AJ (2008) Endoscopic injection of dextranomer hyaluronic acid copolymer for the treatment of vesicoureteral reflux in duplex ureters. J Pediatr Urol 4(5):372–376

    Article  PubMed  Google Scholar 

  9. Dursun H, Bayazit AK, Buyukcelik M et al (2005) Associated anomalies in children with congenital solitary functioning kidney. Pediatr Surg Int 21(6):456–459

    Article  PubMed  Google Scholar 

  10. Song JT, Ritchey ML, Zerin JM et al (1995) Incidence of vesicoureteral reflux in children with unilateral renal agenesis. J Urol 153(4):1249–1251

    Article  PubMed  CAS  Google Scholar 

  11. Cascio S, Paran S, Puri P (1999) Associated urological anomalies in children with unilateral renal agenesis. J Urol 162(3 Pt 2):1081–1083

    PubMed  CAS  Google Scholar 

  12. Karnak I, Woo LL, Shah SN et al (2008) Prenatally detected ureteropelvic junction obstruction: clinical features and associated urologic abnormalities. Pediatr Surg Int 24(4):395–402

    Article  PubMed  Google Scholar 

  13. Hollowell JG, Altman HG, Snyder HM 3rd et al (1989) Coexisting ureteropelvic junction obstruction and vesicoureteral reflux: diagnostic and therapeutic implications. J Urol 142(2 Pt 2):490–493 (discussion 501)

    PubMed  CAS  Google Scholar 

  14. Bomalaski MD, Hirschl RB, Bloom DA (1997) Vesicoureteral reflux and ureteropelvic junction obstruction: association, treatment options and outcome. J Urol 157(3):969–974

    Article  PubMed  CAS  Google Scholar 

  15. Cascio S, Sweeney B, Granata C et al (2002) Vesicoureteral reflux and ureteropelvic junction obstruction in children with horseshoe kidney: treatment and outcome. J Urol 167(6):2566–2568

    Article  PubMed  CAS  Google Scholar 

  16. Pitts WR Jr, Muecke EC (1975) Horseshoe kidneys: a 40-year experience. J Urol 113(6):743–746

    PubMed  Google Scholar 

  17. Kramer SA, Kelalis PP (1984) Ureteropelvic junction obstruction in children with renal ectopy. J Urol (Paris) 90(5):331–336

    CAS  Google Scholar 

  18. Guarino N, Tadini B, Camardi P et al (2004) The incidence of associated urological abnormalities in children with renal ectopia. J Urol 172(4 Pt 2):1757–1759 (discussion 1759)

    Article  PubMed  Google Scholar 

  19. Arena F, Arena S, Paolata A et al (2007) Is a complete urological evaluation necessary in all newborns with asymptomatic renal ectopia? Int J Urol 14(6):491–495

    Article  PubMed  Google Scholar 

  20. Cerwinka WH, Scherz HC, Kirsch AJ (2007) Endoscopic treatment of vesicoureteral reflux associated with paraureteral diverticula in children. J Urol 178(4 Pt 1):1469–1473

    Article  PubMed  Google Scholar 

  21. Gupta L, Sharma S, Gupta DK (2010) Is there a need to do routine sonological, urodynamic study and cystourethroscopic evaluation of patients with simple hypospadias? Pediatr Surg Int 26(10):971–976

    Article  PubMed  Google Scholar 

  22. Kulkarni BK, Oak SN, Patel MP et al (1991) Developmental anomalies associated with hypospadias. J Postgrad Med 37(3):140–143

    PubMed  CAS  Google Scholar 

  23. Kim KH, Lee HY, Im YJ et al (2011) Clinical course of vesicoureteral reflux in patients with hypospadias. Int J Urol 18(7):521–524

    Article  PubMed  Google Scholar 

  24. Silva JM, Diniz JS, Lima EM et al (2009) Independent risk factors for renal damage in a series of primary vesicoureteral reflux: a multivariate analysis. Nephrology (Carlton) 14(2):198–204

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. National Children’s Research Centre, Our Lady’s Children’s Hospital, Dublin-12, Ireland

    Manuela Hunziker, Balazs Kutasy, Federica D’Asta & Prem Puri

  2. National Children’s Hospital, Dublin, Ireland

    Manuela Hunziker, Balazs Kutasy, Federica D’Asta & Prem Puri

Authors
  1. Manuela Hunziker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Balazs Kutasy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Federica D’Asta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Prem Puri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Prem Puri.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hunziker, M., Kutasy, B., D’Asta, F. et al. Urinary tract anomalies associated with high grade primary vesicoureteral reflux. Pediatr Surg Int 28, 201–204 (2012). https://doi.org/10.1007/s00383-011-2986-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-011-2986-1

Keywords

Search

Navigation