[Primary uretero-vesical malposition without radiological reflux (author's transl)]

Area of Science:

• Pediatric Urology
• Nephrology
• Surgical Innovation

Background:

• Vesico-ureteric reflux (VUR) is a common cause of urinary tract infections in children.
• Contralateral malformations in VUR cases are frequently observed.
• Some children experience recurrent pyelonephritis without demonstrable radiological VUR.

Purpose of the Study:

• To evaluate the efficacy of anti-reflux surgery in children with uretero-vesical malformations.
• To investigate the outcomes of surgical intervention in cases of recurrent pyelonephritis without radiological VUR.
• To validate the concept of 'reflucing uretero-vesical malpositions without radiological reflux'.

Main Methods:

• Retrospective analysis of 190 children with unilateral VUR.
• Surgical intervention (anti-reflux procedures) in selected pediatric patients.
• Comparison of outcomes in children with and without radiological VUR.

Main Results:

• Bilateral anti-reflux surgery in 94 children with unilateral VUR and contralateral malformations prevented recurrent pyelonephritis in most cases.
• In 18 children with recurrent pyelonephritis and uretero-vesical malformations but no radiological VUR, anti-reflux surgery led to resolution of infections.
• Corticopapillary scarring was observed in 9 of these 18 children.

Conclusions:

• Anti-reflux surgery is effective in managing recurrent pyelonephritis associated with uretero-vesical malformations, irrespective of radiological reflux.
• The study supports the identification of a distinct group of 'reflucing uretero-vesical malpositions without radiological reflux'.
• Surgical intervention can significantly reduce pyelonephritis episodes in this specific pediatric population.