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Direct Vesicoureteral Scintigraphy: Quantifying Early Outcome Predictors in Children with Primary Reflux

Division of Nuclear Medicine and Department of Urology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania

Correspondence: For correspondence and reprints contact: P. David Mozley, MD, 110 Donner Building, H.U.P., 3400 Spruce St., Philadelphia, PA 19104.

ABSTRACT

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.

Key Words: vesicoureteric reflux • prognosis • outcome

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