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Master Thesis

Reflux vésico-urétéral primaire chez l'enfant : évolution dans l’enfance du traitement conservateur

Abstract : Background: Kidney damages from persistent asymptomatic vesicoureteral reflux (VUR) remain poorly documented and publications on this topic are limited. The aim of our study was to determine whether an persistent, non-operated and asymptomatic VUR after the age of 3 years, had any consequences on the kidneys function. Methods: In the department of Pediatric Surgery at CHU la Réunion, we followed all children younger than 3 years, diagnosed with VUR by VCUG (Voiding Cystourethrogram), further investigated with a 99mTc-DMSA renal scan (DMSA scan 1), and not operated between 2004 and 2012. The observation was continued beyond the age of 6 and ended with an additional DMSA renal scan (DMSA scan 2) and was compared with the initial DMSA renal scan. If a Urinary Tract Infection (UTI) occurred during the follow-up period, a surgical approach was discussed. Results: Among the 60 patients enrolled, 42 patients (24 males) were investigated following the protocol (18 were lost to follow-up). The VUR was diagnosed mainly after a febrile UTI (85.7%,36/42) and was considered as low grade in 85.2% (52/61 renal units) of the cases. The DMSA scan 1 was performed at a median age of 2 years and 6 months and was abnormal in 35.7% (15/42) of cases: 4 cases of functional asymmetry associated with renal scar and 11 cases of isolated functional asymmetry. After a median follow-up period of 5 years and 9 months, 88.1% (37/42) did not present with a recurrent UTI. The DMSA scan 2 was not different in 88.2% (30/34) of cases but documented a new renal scar in one case, an increase in functional asymmetry in one other case and in two patients with bilateral VUR: one had an appearance of the split-function, and the other had an increase of the split-function. Conclusion: The results of this study showed that the persistence of an asymptomatic VUR is hardly ever source of renal scarring. The usefulness of a surgical correction in these cases remains to be proven.
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Master Thesis
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Submitted on : Tuesday, January 25, 2022 - 6:25:44 AM
Last modification on : Wednesday, January 26, 2022 - 3:24:24 AM
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Rani Kassir. Reflux vésico-urétéral primaire chez l'enfant : évolution dans l’enfance du traitement conservateur. Sciences du Vivant [q-bio]. 2021. ⟨dumas-03541890⟩



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