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Follow-up evaluation of anomalies of the vesicoureteric junction
1Second Children's Department, Postgraduate Medical University, Borsod County Hospital, Miskolc, Hungary.
Insights
Vesicoureteric junction anomalies in babies, including obstruction and reflux, can lead to urinary tract infections. Early detection and surgical intervention show positive outcomes, preserving renal function.
Area of Science:
- Pediatric Urology
- Medical Imaging
- Surgical Interventions
Background:
- Anomalies of the vesicoureteric junction (VUJ) are clinically significant, often leading to urinary tract infections (UTIs).
- Vesicoureteric reflux (VUR) and obstruction are key concerns in pediatric urinary tract anomalies.
- Prenatal and postnatal ultrasound are crucial for detecting urinary tract dilatation.
Purpose of the Study:
- To analyze the incidence and management of vesicoureteric junction anomalies in infants.
- To evaluate the outcomes of surgical and conservative treatments for these anomalies.
- To assess the role of ultrasonography in monitoring treatment response.
Main Methods:
- Retrospective review of 52 infants with urinary tract dilatation over a 5-year period.
- Classification of VUJ anomalies including VUR, ureteroceles, and stenosis.
- Analysis of surgical interventions, timing, and outcomes, alongside conservative management.
Main Results:
- Sixteen infants (30.8%) had VUJ anomalies: 9 with VUR, 3 ureteroceles, 1 urethral stenosis with reflux, 3 VUJ stenosis.
- 10 patients underwent 14 surgical procedures, with a mean time to surgery of 9.3 months.
- Ultrasonography confirmed regression of dilatation post-surgery; 7 with minor dilatation are under observation. Renal parenchyma loss occurred in only 1 case.
Conclusions:
- Vesicoureteric junction anomalies require prompt diagnosis and management to prevent complications like UTIs and renal damage.
- Surgical intervention for significant dilatation and anomalies leads to favorable outcomes, with successful regression of hydronephrosis.
- Conservative management is viable for minor dilatations, while VUR may necessitate earlier surgical consideration based on progression.
Abstract:
Anomalies of the vesicoureteric junction are important, particularly obstruction and reflux, as they may predispose to urinary tract infection. Over a 5-year period, 52 babies were referred with dilatation of the urinary tract detected antenatally or/and postnatally by ultrasound. Sixteen had an anomaly of the vesicoureteric junction: 9 had vesicoureteric reflux, 3 had ureteroceles, 1 had urethral stenosis with secondary reflux and 3 had stenosis of the vesicoureteric junction. Ten patients underwent 14 surgical procedures. The mean time to reconstructive surgery was 9.3 months. Ultrasonography showed regression of the dilatation in all patients who underwent surgery. Seven patients with minor dilatation are still under observation. In only 1 case was there loss of renal parenchyma. With conservative medical treatment the patients are 1 year old before reconstructive surgery is undertaken; with reflux, however, progression may indicate earlier surgery.