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Unilateral ureteric reimplantation for primary vesicoureteric reflux in children. A policy re-evaluated
Insights
Unilateral ureteric reimplantation for primary vesicoureteric reflux (VUR) was successful in most children. However, some experienced contralateral VUR, and severely affected kidneys showed poor function, suggesting nephrectomy might be better initially for these cases.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Outcomes
Background:
- Primary vesicoureteric reflux (VUR) is a common condition in children, often leading to urinary tract infections and potential kidney damage.
- Ureteric reimplantation is a standard surgical procedure to correct VUR.
- Long-term outcomes and the management of severely affected kidneys require further investigation.
Purpose of the Study:
- To evaluate the efficacy and complications of unilateral ureteric reimplantation for primary VUR in children.
- To assess the renal function in patients with scarred or dysplastic kidneys post-reimplantation.
- To determine if nephrectomy is a more suitable initial approach for severely compromised kidneys.
Main Methods:
- A retrospective review of 51 children undergoing unilateral ureteric reimplantation for primary VUR over 11 years.
- Assessment of reflux resolution and development of contralateral VUR.
- Isotope renal scans (99mTc DMSA) were performed on 18 patients with scarred or dysplastic kidneys.
Main Results:
- Reflux was abolished in 50 out of 51 patients.
- Contralateral VUR developed or worsened in 8 patients (15.7%).
- In patients with scarred/dysplastic kidneys, 13 had <22% function in the affected kidney, and 7 had <10% GFR from the reimplanted kidney's side. Five of these underwent nephrectomy, which was considered a better initial option.
Conclusions:
- Unilateral ureteric reimplantation is highly effective in resolving primary VUR.
- Careful assessment of renal function is crucial, as nephrectomy may be preferable for severely scarred or dysplastic kidneys.
- No patients developed hypertension post-operatively.
Abstract:
Fifty-one children had unilateral ureteric reimplants for primary vesicoureteric reflux over an 11-year period. Reflux was abolished in 50 patients but in 8 (15.7%) it developed or became worse on the contralateral side. An isotope renal scan (99mTc DMSA) was carried out in 15 of the 18 patients who had grossly scarred or dysplastic kidneys. Thirteen of these had less than 22% of total function coming from the affected kidney and seven had less than 10% of their total GFR coming from the kidney whose ureter had previously been reimplanted. Five of these children have undergone nephrectomy and it is felt that this would have been a better initial procedure. No patient was hypertensive at the conclusion of the study.