[Clinical study in infants with vesicoureteral reflux]
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S Kunikata1, K Kohri, T Akiyama
1Department of Urology, Kinki University Medical School.
Insights
Early antireflux surgery is crucial for infants with vesicoureteral reflux (VUR) and kidney damage. Conservative VUR treatment showed poor outcomes, while surgery effectively resolved reflux, especially with a modified approach.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Innovation
Context:
- Vesicoureteral reflux (VUR) affects infants, potentially leading to kidney damage.
- Conservative management of VUR has shown limited success and challenges in long-term follow-up.
- Surgical intervention is often considered for VUR management.
Purpose:
- To evaluate the outcomes of conservative management versus antireflux surgery in infants with VUR.
- To assess the efficacy and safety of a modified Politano-Leadbetter surgical technique.
- To determine the impact of antireflux surgery on renal function and growth in affected infants.
Summary:
- A study of 52 infants with VUR compared conservative treatment (12 infants) with antireflux surgery (40 infants).
- Conservative treatment resulted in spontaneous reflux resolution in only 2 infants, with high dropout rates.
- Antireflux surgery, particularly a modified Politano-Leadbetter method, resolved reflux in all cases, with minimal complications.
- Renal function and growth were not improved in severely damaged or atrophic kidneys post-surgery.
Impact:
- Highlights the limited efficacy of conservative VUR management in infants.
- Demonstrates the effectiveness and safety of a modified Politano-Leadbetter antireflux operation.
- Emphasizes the importance of early detection and surgical intervention for high-grade VUR or impaired renal function in infants to prevent further kidney damage.
Abstract:
A clinical study was performed on 52 infants up to 2 years old with vesicoureteral reflux. We treated 12 of them conservatively. Half of them dropped out within 1 year. It was very difficult to follow up the infants over a long time in the conservative treatment group. As a result of the conservative treatment, reflux disappeared spontaneously in only 2 infants. Forty infants underwent antireflux operations. The reflux disappeared in all cases. However, we injured the peritoneum in 2 cases when the Politano-Leadbetter method was applied. A modified Politano-Leadbetter method was adopted because of the peritoneum injury. As an antireflux operation on infants, the modified Politano-Leadbetter method is desirable. Renal function and growth were studied. Renal function was assessed with 99m-Tc-DTPA renograms. Renal ratio was evaluated by intravenous pyelography. The function of refluxing kidneys Severely damaged was not improved after the antireflux operations. The small kidneys with a high grade or the atrophic kidneys did not demonstrate normalization of renal growth after antireflux operations. In conclusion, it is important to detect the reflux at the early infant stage and perform the antireflux operation at an early stage in the case of high grade or renal impairment.