Surgical Management of Primary Vesicoureteral Reflux
Keywords:
Surgical Management, Primary Vesicoureteral RefluxAbstract
Objective: To collect and evaluate result of surgical management of severe primary vesicoureteral reflux (VUR) in pediatric patients at Prapokklao Hospital, Chantaburi.
Material and method: Collection of pediatric patients with severe grade of primary vesicoureteral reflux at surgical department between 2000-2005 were reviewed. Age, sex, type of VUR, presenting symptoms, radiologic finding and operative techniques were reviewed.
Results: There were 22 cases, 14 girls and 8 boys with primary, severe grade VUR. Thirteen cases had unilateral VUR and 9 cases had bilateral VUR. Presenting symptoms were recurrent UTI (100%), urosepsis (9%), abnormal urination (23%), palpable kidney (4%), failure to thrive (4%). Surgical procedures in unilateral VUR were Politano-Lead better ureteroneocystostomy 3 cases, Glenn-Anderson reimplantation 10 cases. In cases of bilateral VUR, Cohen-cross trigone reimplantation were used in 9 cases. Primary VUR with megaureter were found in 3 cases, tapering of lower end ureter with reimplantation were performed in 2 cases and in 1 case tapering of the whole ureter with reimplantation was performed.
Conclusion: In severe grade VUR (gr.V) and bilateral VUR, surgical reimplantation of ureters were considered. The results were excellent and complication was minor.
References
Cooper CS, Austin JC. Vesicoureteral reflux : Who benefits from surgery?. Urol Clinn.am 31(2004): 535-41.
Elder JS, Peters CA, Arant BS Jr, Ewalt DH, Hawtrey CE, Hurwitzrs E. Pedriatic vesicoureteral reflux guidelines panel summary report on the management of primary vesicoureteral reflux in children. J Urol 1991; 157: 1846-51.
Politano VA, Lead better WF. An operative techique for the correction of vesicoureteral reflux. J Urol 1958; 79: 932-41.
Glen JF, Anderson EE. Distal tunnel ureteral reimplantation. J Urol 1967; 97: 623-6.
Cohen SJ., Ehrlich RM. Success of the transvesical advancement technique for vesicoureteral reflux. J Urol 1982; 128: 554-7.
Diamond DA, Rabinowitz R, Hoenig D, Caldamone AA. The mechanism of new onset contralateral reflux following unilateral ureteroneocystostomy. J Urol 1996; 156: 665-7.
Hoenig DM, Diamond DA, Rasinowitz R, Caldamone AA. Contralateral reflux after unilateral reimplatation. J Urol 1996; 156: 196-7.
Atala A, Kavoussi LR, Goldstein DS, Retink AB, Peters CA. Laparoscopic correction of vesicoureteral reflux. J Urol 1993; 150: 748-51.
Puri P, Granata C. Multicenter survey of endoscopic treatment of vesicoureteral reflux using polytetrafluroethylene. J Urol 1998; 160: 1007-11.
