Reply by the Authors

摘要

We acknowledge the comments of our readers and take this opportunity to clarify some points regarding our original paper.We agree that all patients should ideally have both a pre- and postoperative DMSA scan to document scarring. However, in our population, only 15% of patients showed renal scars on preoperative imaging after recur-rent pyelonephritis, thus making the odds of new ones extremely low, especially without other infection. Furthermore, we assert that renal scarring after pyelonephritis is a rare event in adults as compared to the pediatric population. Early treatment was shown to be effective in preserving nephron integrity. In our study, we did not consider observation to be an alternative option because of the recurring pattern of pyelonephritis; most patients had already failed conservative management, ie, observation, antibiotic prophylaxis, or treatment of dysfunctional voiding. We argue that the control of infective events alone had a great impact on the patients who needed admission. Loss of productivity with major impact on daily activities for several days was documented for a large number of patients.