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[Pyelo-ureteral duplication and vesico-ureteral reflux]
Insights
Vesico-ureteric reflux in children often requires surgical intervention, as medical treatments are rarely effective. Cohen's ureterocystoneostomy shows promise but can lead to renal scarring and persistent infections.
Area of Science:
- Pediatric Urology
- Nephrology
Background:
- Vesico-ureteric reflux (VUR) is a common condition in children, potentially leading to kidney damage.
- Double upper urinary tracts present unique challenges in managing VUR.
Purpose of the Study:
- To evaluate the outcomes of various treatment protocols for VUR in children with double upper urinary tracts.
- To compare the efficacy of medical management, nephrectomy, and surgical techniques like Cohen's ureterocystoneostomy.
Main Methods:
- Retrospective analysis of 106 children (76 girls, 30 boys) treated for VUR in double upper urinary tracts.
- Review of outcomes associated with medical treatment, partial/total nephrectomy, and Cohen's "en bloc" ureterocystoneostomy.
Main Results:
- Medical treatment demonstrated limited success rates.
- Nephrectomy was sometimes required due to severe renal dysfunction.
- Cohen's technique effectively addressed reflux but resulted in unsatisfactory outcomes due to renal scarring and persistent urinary infections.
Conclusions:
- Surgical intervention, particularly Cohen's ureterocystoneostomy, offers the best conservative approach for VUR in this patient group.
- Despite successful reflux management, long-term renal health remains a concern due to potential scarring and infection post-surgery.
Abstract:
106 children (76 girls and 30 boys) were treated for vesico-ureteric reflux in double upper urinary tracts. The results of different treatment protocols are discussed. Medical treatment is rarely successful. Partial or total nephrectomy is sometimes necessary because of very poor renal function. Cohen's technique for the "en bloc" ureterocystoneostomy of the two ureters seems to provide the best conservative treatment. But the results, which are good as far as the reflux is concerned, are often unsatisfactory because of the scarring of the renal parenchyma, especially as regards the inferior pole, and because of persistent urinary infection.