VESICOURETERAL REFLUX INCIDANCE IN CHILDREN WITH URINARY STONE DISEASE

Introduction: In spite of the frequent association of urinary infection with vesicoureteric reflux and

urinary calculi, the coexistence of vesicoureteric reflux and calculi is rare. Four factors (urinary calculi,

urinary tract infection, structural changes at the uretero vesical junction and reflux) may interact in these

cases. In this prospective study we studied the prevalence of vesicoureteral reflux (VUR) in children with

urinary stone disease.

Materials and Methods: Between September 2000 and March 2004 we evaluated the prevalence of VUR in

children with urinary stone disease. In all patients history, physical examination, biochemical and

microbiologic analyses were done before the treatment of stone disease. We did voiding cystouretrography in

all patients. Patients were divided based on surgical method, including extracorporeal shock wave lithotripsy

(ESWL), endoscopy and open surgery. Some patients required combined treatment. After the treatment of

stone disease, all patients with VUR received suppressive antibiotic treatment. During follow up period

surgical treatment was applied when necessary.

Results: Fifty children between 1.5 and 13 years old (median 6.75 years) were included in this study. 41 of

patients (82%) were male, 9 (18%) were female. In 37 of patients stone was located only in kidney, 8 were

located in urethra, 2 had kidney and bladder stones, 2 had kidney and urethra stones simultaneously. Only 1

patient had bladder stone. In 6 patients (3 male, 3 female) VUR was diagnosed with voiding

cystouretrography. Of the patients 2 had bilateral reflux (1 patient with bilateral calculi and the other with

left kidney and bladder calculi), 2 had right side reflux (1 had urethra calculi and 1 has contralateral kidney

calculi), 2 had left side reflux (1 on ipsilateral kidney calculi and 1 on ipsilateral ureteral calculi). The

prevalence of VUR was 12%.

Conclusion: In children with urinary stone disease one must always remember that VUR can be seen

simultaneously. So if necessary VSUG should always be applied. All patients with urinary stones, particularly

staghorn calculi, and urinary tract infection have to be examined for vesicouretral reflux, after the stone or

stones have been removed and appropriate antimicrobial therapy has been given.