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Klinischer Verlauf und Narbenentwicklung beim operierten vesico-renalen Reflux in einer Langzeitbeobachtung

Long-term follow-up of children with surgically treated vesico-renal reflux: Postoperative incidence of urinary tract infections and renal scarring

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Summary

62 patients (14 boys, 48 girls) representing 85 refluxive renal units (Grade 2–4) were investigated after successful operation for the development of further urinary tract infections (UTI) and renal scars (RS). The mean follow-up was 9.3 years. With the exception of one boy, none of the male patients developed any UTI or new RS. A similar result was obtained for about 45% of the girls. These two groups of patients presented with high-grade reflux before surgery. The remaining female patients (about 55%), however, presenting with lower-grade reflux before surgical treatment, developed further UTI as well as new RS despite surgical correction of their reflux. Investigations on the capacity of uroepithelial cells (UEC) to suppress bacterial growth revealed a deficient antibacterial effect of UEC in these patients. Such an UEC defect has also been shown in patients with asymptomatic bacteriuria. In conclusion, different reasons seem to be responsible for recurrent UTI and the development of RS in patients with reflux.

Zusammenfassung

62 Patienten (14 Knaben, 48 Mädchen), bei denen an insgesamt 85 Niereneinheiten ein vesico-renaler Reflux (Grad 2–4) erfolgreich operiert worden war, wurden im Durchschnitt 9,3 Jahre postoperativ auf das Auftreten von Harnwegsinfektionen (HWI) und von neuen Nierenparenchymnarben (NN) verfolgt. Bei den männlichen Patienten traten postoperativ bis auf einen Knaben keine HWI bzw. NN auf. Ähnliches galt auch für etwa 45% der Mädchen. Beide Gruppen von Patienten wiesen vor Operation hohe Refluxgrade auf. Bei den übrigen Mädchen, deren präoperative Reflux-Grade im Durchschnitt relativ niedrig lagen, traten jedoch postoperativ über Jahre noch HWI auf. NN entwickelten sich vorwiegend in dieser Zeit. Untersuchungen der Fähigkeit von Uroepithelzellen (UEZ), das Bakterienwachstum zu hemmen, zeigten, daß die UEZ dieser Patienten das Bakterienwachstum nicht supprimieren konnten. Somit entsprachen diese Mädchen bezüglich ihrer UEZ-Funktion Patientinnen mit asymptomatischer Bakteriurie. HWI und NN bei Reflux scheinen somit durch unterschiedliche Ursachen ausgelöst zu werden.

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Schulte-Wissermann, H., Beetz, R., Ludwig, K.H. et al. Klinischer Verlauf und Narbenentwicklung beim operierten vesico-renalen Reflux in einer Langzeitbeobachtung. Klin Wochenschr 63, 920–926 (1985). https://doi.org/10.1007/BF01738146

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