Risk factors effective in regression of congenital vesicoureteral reflux

Vesicoureteral reflux (VUR) is the most common congenital urinary system anomaly in childhood. Conservative and medical approaches and surgical applications are included in the treatment. In this study, it was aimed to determine the factors affecting reflux stage regression in patients diagnosed with congenital VUR. This single center, retrospective study was conducted between January 2016 and December 2021 at Eskişehir Osmangazi University, Faculty of Medicine, Department of Pediatrics. Demographic information, age at admission, USG and VCUG findings, febril UTIs, presence of scarring in DMSA, prophylactic antibiotic use, and type of surgery of 70 patients diagnosed with VUR before the age of one were evaluated. 60% of the patients were male. The mean age at first admission was 3.7±3.2 months; mean age at diagnosis was 6.4±3.6 months. 51.4% had antenatal hydronephrosis and 77.7% of these patients were male. 55.7% had high-grade reflux. 24.3% had one UTI attack, 42.9% had two or more UTIs. The history of UTI was higher in girls (p=0.01). Unilateral scar was detected in 32.9% of them, and there was no patient with bilateral scar. Spontaneous resolution was observed in the reflux stage in 24.1% (9 girls, 8 boys). 41.2% of these patients had a history of antenatal hydronephrosis. Low-grade reflux was present in 58.8%. Low-grade reflux was more common in the group with spontaneous regression, and high-grade reflux was more common in the group without spontaneous regression (p=0.000). Renal scar was present in 11.8% of the group with spontaneous regression and in 39.6% of the group without spontaneous regression (p=0.04). Right reflux was higher in the group with spontaneous regression, and bilateral reflux was higher in the group without spontaneous regression (p=0.02). In conclusion; Patients with a diagnosis of VUR, to predict spontaneous regression; Gender, reflux degree, side of reflux, presence of antenatal hydronephrosis, history of UTI, presence of scarring in DMSA, renal antero-posterior diameter increase in USG and parenchymal thinning should be evaluated. An individualized approach is still needed to predict spontaneous regression. Key Words: Vesicoureteral reflux, reflux regression, antenatal hydronephrosis