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[Urinary tract infections and renal growth after antireflux operations in children]
Insights
Bilateral ureter reimplantation in children prevented reflux but 28% still experienced recurrent urinary tract infections. Most post-operative infections were lower tract, unlike pre-operative pyelonephritis, though renal growth was mostly normal.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Outcomes
Background:
- Recurrent urinary tract infections (UTIs) and impaired renal growth are significant concerns in children.
- Bilateral re-implantation of the ureters is a surgical procedure to correct vesicoureteral reflux (VUR).
Purpose of the Study:
- To assess renal growth and the incidence of recurrent UTIs in children following bilateral ureter reimplantation.
- To evaluate the impact of the surgical procedure on infection patterns and kidney development.
Main Methods:
- A cohort of 116 children undergoing bilateral ureter reimplantation was studied.
- Renal growth and the occurrence of UTIs were monitored post-operatively.
Main Results:
- Vesicoureteral reflux was successfully prevented in all children.
- Despite successful reflux prevention, 28% of children experienced recurrent UTIs post-operatively.
- Post-operative infections were predominantly lower urinary tract infections, contrasting with pre-operative acute pyelonephritis.
- 82% of kidneys exhibited normal growth, with a 4.5% increase in growth rate, which is lower than reported in other series.
- 13.5% of kidneys showed slower growth, often associated with pre-existing radiological abnormalities.
Conclusions:
- Bilateral ureter reimplantation effectively prevents VUR but does not eliminate recurrent UTIs in a significant proportion of children.
- Post-operative infection patterns shift towards the lower urinary tract.
- Renal growth is generally preserved, although a small percentage may experience slower growth, particularly those with pre-operative renal abnormalities.
Abstract:
An assessment has been made of renal growth and of the incidence of recurrent urinary tract infection in 116 children who had bilateral re-implantation of the ureters. Although reflux was prevented, 28% of the children continued to have infections long after the operation. The infections were mostly of the lower urinary tract whereas before the operation there was a significant incidence of acute pyelonephritis. After operation 82% of the kidneys grew normally and in 4,5% growth rate increased which is a smaller proportion than that reported in other series. In contrast 13,5% of the kidneys grew more slowly but they were usually abnormal radiologically before the operation.