Vesicoureteral Reflux Fixed; Kidneys Not Fixed! – A Case Series

Abstract

ABSTRACT Surgery is advocated in high-grade vesicoureteral reflux (VUR) in children (grades 4 and 5) to prevent recurrent urinary tract infections (UTIs) and prevent kidney damage. Recent studies have shown that the risk of recurrent UTIs is minimal, even with conservative management. In the three cases presented here, reimplantation of the ureters was done to abolish high-grade VUR. Yet these children have abnormal kidney function and proteinuria on long-term follow-up (10 years and more), though kidney function was normal at the time of surgery. The surgical procedures to correct the high-grade VUR do not preclude the kidney damage entirely. These children often are born with dysplastic kidneys. The outcome in terms of kidney function depends on many factors, such as the degree of dysplasia that is present in the kidneys at birth, proteinuria, hypertension, bladder-bowel dysfunction, and recurrent UTI. Abolishing VUR by surgical means does not seem to change the outcome.