Long-term incidence of urinary tract infection after ureteral reimplantation for primary vesicoureteral reflux.

Abstract

OBJECTIVE: To determine the incidence of urinary tract infection (UTI) after ureteral reimplantation (UR) for primary vesicoureteral reflux (VUR). MATERIALS AND METHODS: In this retrospective review, the pyelonephritis-free survival of patients with primary VUR who underwent open UR from January 1990 to December 2002 was assessed using a Cox proportional hazards analysis. RESULTS: 1076 patients underwent open UR for primary VUR. 73.0% were female; median age was 4.7 years. 80.1% presented with UTI. Clinical success rate for non-tapered UR was 96.5%. Median follow-up was 2.9 years. 21.8% had at least one postoperative UTI. 6.5% had postoperative pyelonephritis (POP) at a median of 21 months postoperatively. On multivariate survival analysis female gender (OR 9.97, 95% CI 3.07-32.34), preoperative VUR grade ≥3 (2.14, 1.25-3.69), breakthrough preoperative UTI (2.00, 1.22-3.25), and preoperative renal scarring (1.86, 1.15-2.99) were associated with POP. CONCLUSION: POP is rare on long-term follow-up, suggesting that UR is effective in reducing pyelonephritis in this population.