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[Surgical therapy of vesicoureterorenal reflux in children]
Insights
Antireflux operations reliably correct vesico-ureteral reflux in children, regardless of surgical technique. Risk factors and specific conditions guide treatment strategies for optimal outcomes.
Area of Science:
- Pediatric Urology
- Surgical Techniques
- Renal Health
Background:
- Vesico-ureteral reflux (VUR) is a common condition in children.
- Concomitant malformations often present alongside VUR.
- Previous studies established the need for effective antireflux interventions.
Purpose of the Study:
- To evaluate the efficacy of various antireflux operations in children.
- To identify risk factors influencing treatment strategies for VUR.
- To compare surgical outcomes with historical data.
Main Methods:
- Analysis of 433 ureters treated between 1977-1982.
- Comparison of extravesical (Lich-Grégoir) and intravesical (Politano-Leadbetter) techniques.
- Inclusion of intra- and extravesical ureteroneocystostomies.
Main Results:
- All antireflux operations reliably established an antireflux mechanism.
- Surgical intervention is primary for VUR with Hutch's diverticulum, ureterocele, or double ureters.
- Antireflux surgery is recommended for high-risk groups, including post-obstruction correction and sphincter-detrusor-dyssynergia.
Conclusions:
- Antireflux surgery is effective for pediatric vesico-ureteral reflux.
- Identifying risk factors and associated pathologies guides surgical decision-making.
- Surgery is a viable alternative to antibiotic prophylaxis in cases of poor compliance.
Abstract:
Extravesical antireflux operations following Lich-Grégoir technique, intravesical Politano-Leadbetter technique as well as intra- and extravesical ureteroneocystostomies have been done on 433 ureters from 1977 to 1982 treating children with vesico-ureteral reflux and different concomitant malformations. Compared with results obtained in this institute from 1968 to 1973 antireflux operations were found to reliably form an antireflux mechanism whatever technique is used. Results of the "International Reflux Study Group" will be available in the near future. Looking at the variety of conditions grouped together under the diagnosis of vesico-uretero-renal reflux risk factors can be identified directing treatment strategy and surgical intervention. In children with concomitant vesical pathology like Hutch's diverticulum, ureterocele formation and refluxing double ureter surgery is primarily used. Children after correction of infravesical obstruction should be regarded as a high risk group and be submitted to antireflux surgery if reflux does not resolve spontaneously shortly after relief of infravesical obstruction. It is in children with sphincter-detrusor-dyssynergia causing functional infravesical obstruction where antireflux surgery is recommended if micturition without residual urine is not restored quickly. Finally in cases of poor patient compliance antibiotic prophylaxis should be omitted and substituted by antireflux surgery.