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[Clinical analysis of primary vesicoureteral reflux in children]
Insights
Surgical intervention for primary vesicoureteral reflux in children showed higher success rates than conservative chemotherapy. The Politano-Leadbetter procedure effectively cured reflux in all treated units.
Area of Science:
- Pediatric Urology
- Nephrology
Context:
- Vesicoureteral reflux (VUR) is a common condition in children, increasing the risk of urinary tract infections and renal damage.
- Management strategies for VUR include conservative (chemotherapy) and surgical approaches.
Purpose:
- To compare the efficacy of conservative management (chemotherapy) versus surgical intervention (Politano-Leadbetter procedure) for primary vesicoureteral reflux in pediatric patients.
Summary:
- A retrospective analysis reviewed 64 pediatric patients with primary VUR. Group A (31 patients) received chemotherapy, while Group B (28 patients) underwent the Politano-Leadbetter anti-reflux surgery. Spontaneous resolution occurred in 13/30 units in Group A. All 39 units in Group B showed successful reflux cure post-surgery.
- Renal function, assessed by excretory urography (IVP) and renography, showed mixed results in Group A, with some improvement and some deterioration. Group B demonstrated improvement in 13/39 units via IVP and 8/28 units via renography post-operatively.
Impact:
- Surgical treatment using the Politano-Leadbetter procedure appears to be highly effective in curing primary vesicoureteral reflux in children.
- Further analysis considering VUR grading is warranted to refine treatment strategies and predict outcomes.
Abstract:
The retrospective analysis of 64 patients between 1 month and 14 years old with 87 primary vesicoureteral units with reflux was reviewed. They were followed-up for a period of 3 to 60 months. Thirty one patients were managed conservatively by chemotherapy (group A) and 28 patients were treated surgically. As the anti-reflux operation the Politano-Leadbetter procedure was used in 27 patients and the modified Politano-Leadbetter procedure in 1 patient (group B). Five patients were not treated (group C). In 13 of the 30 renal units of group A, the vesico-ureteral reflux disappeared spontaneously and in group B the post-operative cystourethrography revealed cure of reflux in all the renal units. In 2 of the 21 renal units of group A excretory urography (IVP) revealed improvement and in 3 deterioration. Post-operative IVP revealed improvement in 13 of 39 renal units of group B and in 2 deterioration. In 3 of the 22 renal units of group A the renogram revealed improvement and in 3 deterioration. The post-operative renogram revealed improvement in 8 of the 28 renal units of group B and deterioration in renal units. Analysis was also made according to the vesicoureteral reflux grade.