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[Primary isolated vesico-ureteral reflux in children]
J M Bondonny1, J P Hehunstre, J Carles
1Hôpital des Enfants, Bordeaux.
Insights
Surgical intervention for primary vesico-ureteral reflux in children is recommended for widely dilated ureters. Non-dilated ureters may not require surgery, with treatment decisions based on reflux severity and patient factors.
Area of Science:
- Pediatric Urology
- Surgical Management
- Renal Health
Context:
- Vesico-ureteral reflux (VUR) is a common condition in children.
- Surgical treatment strategies for VUR have evolved.
- Long-term outcomes and complications require careful consideration.
Purpose:
- To evaluate the outcomes of surgical treatment for primary VUR in children.
- To refine therapeutic strategies based on reflux severity and associated renal damage.
- To provide guidance on surgical versus medical management.
Summary:
- Analysis of 382 pediatric cases treated between 1971-1984.
- Recommends surgery for widely dilated ureters, while non-dilated ureters may be managed conservatively.
- Early surgical intervention is advised for severe renal lesions with significant radiological and biochemical alterations.
Impact:
- Informs clinical decision-making for pediatric VUR management.
- Highlights the importance of individualized treatment based on reflux characteristics and patient condition.
- Contributes to optimizing surgical timing and patient selection for improved renal outcomes.
Abstract:
The advantages, complications or sequelae of surgical treatment of primary vesico-ureteral reflux in children are discussed in the light of 382 cases operated upon between 1971 and 1984. Changes in ideas on the fate of primary reflux and its consequences make it necessary to modify our therapeutic strategy, as shown by a study of our records and an exhaustive review of the literature. As a result, we suggest that reflux into a non-dilated ureter should not be operated, whereas reflux into a widely dilated ureter requires surgery. The operation should take place at an early stage in cases with severe renal lesions with pronounced radiological and biochemical alterations. In children with reflux of medium severity, the decision to operate or treat medically must rest on such criteria as age and severity, frequency and resistance of episodes of urinary infection, radiological and endoscopic data and signs of renal tissue functional damage.