Incidence of Post-Ureteric Reimplantation Urinary Tract Infection in Primary Vesicoureteral Reflux

Abstract

Background: The goal of treatment in vesicoureteral reflux (VUR) is to reduce the risk of reflux-associated pyelonephritis. Medical versus surgical treatment for VUR is still controversial, with surgery successful in majority of cases. There are not enough data available in literature on long-term incidence of urinary tract infection (UTI) after reimplantation. The aim of the study was to determine the long-term outcome after reimplantation with respect to UTI, renal scarring and potential risk factors for post-reimplant UTI.

Methods: It is a retrospective review of 106 consecutive cases who underwent reimplantation for primary VUR.

Results: Incidence of post-reimplant UTI is 12.8%. Majority of our patients were females and showed high grade reflux. Median age at surgery was 32 months. Thirteen patients had post-reimplant UTI. Of this, 12/13 were females, 12/13 had pre-reimplant febrile UTI, 10/13 had high grade VUR, 7/13 had urge incontinence and dysfunctional voiding, and 3/13 had constipation. Only two patients showed new scarring/worsening scarring.

Conclusions: It is an established fact that ureteric reimplantation is effective in preventing UTI. Some continue to develop UTI even after successful correction of VUR and it is unclear as to why it happens. Various rates of post-reimplant UTI have been quoted in literature with non-febrile UTI of 40% and febrile UTI of 14%. In our study, febrile UTI rate was 4.9% and non-febrile UTI rate was 7.9%. Post-reimplant UTI resulting in new renal scars is rare. There are some possible risk factors for recurrent UTI after reimplantation, but unfortunately only few of them are reversible (bowel bladder dysfunction). Reimplantation for VUR is a very effective treatment. Incidence of post-reimplant UTI is 12.8% with development of new scars after such UTI is rare. Several risk factors contribute to such UTI.




World J Nephrol Urol. 2016;5(1):1-3
doi: http://dx.doi.org/10.14740/wjnu237w