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[Cohen's operation in the treatment of vesico-ureteral reflux in children]
Insights
Cohen's operation effectively treats pediatric vesico-ureteral reflux (VUR), restoring ureteral function. While some kidney activity may take time to recover, the procedure shows promise for reducing VUR relapses.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Renal Function Assessment
Background:
- Vesico-ureteral reflux (VUR) is a significant condition in children requiring effective surgical intervention.
- Cohen's operation is a surgical technique employed for the treatment of VUR.
- Assessing treatment outcomes requires objective pre- and post-operative evaluations.
Observation:
- This study reviewed Cohen's operation in 43 ureters across 32 children.
- Pre- and post-operative cystography and 131I-hippuran renography were used for assessment.
- Urodynamic recovery was observed in all treated ureters.
Findings:
- Kidney activity showed improvement in 63% of patients one year post-surgery.
- By two years, 13 of 17 patients demonstrated improved kidney function.
- Recurrent VUR was observed in 5.3% of cases, with no ureteral strictures reported.
Implications:
- Cohen's operation demonstrates efficacy in treating pediatric VUR with a low recurrence rate.
- The method is recommended for widespread application to improve surgical care standards for VUR.
- Long-term follow-up suggests that observed renal function deficits are often due to chronic pyelonephritis, not surgical complications.
Abstract:
The present study is a review of the results of Cohen's operation performed on 43 ureters in 32 children. Treatment results were assessed through the comparison of cystographic and 131I-hippuran renographic findings obtained before and after surgery. Urodynamic recovery in the affected ureter was demonstrated in all children. One year after surgery, there was no improvement in the activity of the resected kidney in 37% of patients. In the remaining patients, secretion improved by 10-13% in the affected kidney. Seventeen children returned for follow-up examination 2 years after surgery. The activity of the affected kidney and the contralateral one improved in 13 of 17 patients. There was no upper urinary retention due to ureteral stricture in any of the children. The rate of recurrent vesico-ureteral reflux (VUR) was 5.3%. Augmentation or persistence of purification deficiency in the affected kidney, detected in 12 patients at first postoperative follow-up, was qualified as a result of aggravated chronic pyelonephritis rather than that of surgical complications related to methodologic specifics. This assumption was verified by the results of the next follow-up examination 2 years after surgery. Therefore, Cohen's method can be recommended for large-scale application in the treatment of VUR in children and is expected to essentially reduce the rate of relapses and improve the standards of surgical care of children with this grave disease.