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[Surgical correction of intermittent vesico-ureteral reflux without radiologically detectable reflux]
J Cukier1, S Terdjman, L Z Xun
1Clinique Urologique, Hôpital Necker, Paris.
Insights
Children without radiological evidence of reflux may still have abnormal ureterovesical implantation, suggesting pyelonephritis may not be primary. Anti-reflux surgery showed similar results to those with detected reflux.
Area of Science:
- Pediatric Urology
- Nephrology
- Radiology
Background:
- Vesicoureteral reflux (VUR) is a common cause of pyelonephritis in children.
- Abnormalities in ureterovesical junction (UVJ) implantation can predispose to urinary tract infections.
- Radiological evidence of reflux is typically used to diagnose VUR.
Purpose of the Study:
- To investigate pyelonephritis in children with UVJ abnormalities but no radiological evidence of reflux.
- To determine if absence of reflux excludes primary pyelonephritis under specific conditions.
- To evaluate the efficacy of anti-reflux surgery in this selected group.
Main Methods:
- Retrospective analysis of 62 children with UVJ implantation abnormalities and no radiological reflux.
- Assessment for cortico-papillary renal lesions and recurrent acute pyelonephritis.
- Unilateral or bilateral anti-reflux surgery based on UVJ abnormality laterality.
Main Results:
- Short submucosal ureteric course identified in all studied children.
- Recurrent pyelonephritis occurred even without detectable renal lesions.
- Clinical and bacteriological outcomes post-surgery were comparable to children with radiologically confirmed VUR.
Conclusions:
- Absence of radiological reflux does not rule out primary pyelonephritis in children with specific UVJ abnormalities.
- Surgical correction of UVJ implantation defects can be effective in preventing recurrent infections.
- This finding highlights the importance of considering anatomical variations beyond reflux in pediatric urinary tract infections.
Abstract:
On the basis of a series of 62 children with no radiological evidence of reflux but with an abnormality of a ureterovesical implantation similar to that seen in children with radiologically detected reflux, the authors attempt to show that under certain precise conditions (presence of cortico-papillary renal lesions, recurrent episodes of acute pyelonephritis, even in the absence of renal lesions), the absence of radiologically detectable reflux is not sufficient to confirm the primary nature of pyelonephritis. The sub-mucosal course of the ureters was found to be short in all of these children, and anti-reflux surgery was carried out on one or both sides according to whether the abnormality of uretero-vesical implantation was uni or bilateral. In this small selected group, clinical and bacteriological results were similar to those obtained by anti-reflux surgery in children with radiologically detected vesico-renal reflux.