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Related Experiment Videos

Primary massive reflux in children.

R Rabinowitz, M Barkin, J F Schillinger

    Urology
    |March 1, 1979
    PubMed
    Summary
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    Surgical reconstruction of massively dilated ureters in children with primary vesicoureteral reflux achieved high success rates. Ureteral tailoring and temporary diversion were effective strategies for managing these complex cases.

    Area of Science:

    • Pediatric Urology
    • Surgical Innovation
    • Reflux Management

    Background:

    • Vesicoureteral reflux (VUR) is a common condition in children.
    • Massively dilated ureters present unique surgical challenges.
    • Previous management strategies for severe VUR have varied.

    Purpose of the Study:

    • To evaluate the outcomes of surgical reconstruction for massively dilated ureters in children with primary VUR.
    • To compare the success rates of primary ureteral tailoring versus temporary diversion followed by reimplantation.
    • To assess the long-term renal outcomes in patients with severe VUR and megaureters.

    Main Methods:

    • Retrospective analysis of over 1,000 children treated for primary VUR over a ten-year period.
    • Identification of 54 children with 80 massively dilated ureters.

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  • Surgical intervention included primary ureteral tailoring or temporary diversion followed by reimplantation.

    • Main Results:

    • Primary ureteral tailoring achieved a 92% success rate in 25 ureters.
    • Temporary diversion was performed in 45 ureters due to infection or azotemia.
    • Nontailored reimplantation after diversion had an 87% success rate, with significant improvement in ureteral caliber in nearly half of cases.
    • Overall, 88% of refluxing megaureters were reconstructed with an 89% success rate.
    • Six kidneys were removed, and four showed severe renal dysplasia despite diversion.

    Conclusions:

    • Surgical reconstruction, including ureteral tailoring and temporary diversion, is highly effective for managing massively dilated ureters in pediatric VUR.
    • Temporary diversion can facilitate successful reimplantation by improving ureteral caliber.
    • Careful surgical management is crucial to preserve renal function and minimize complications in severe VUR cases.