Vesicoureteral reflux and ureteropelvic junction obstruction: association, treatment options and outcome
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M D Bomalaski1, R B Hirschl, D A Bloom
1Section of Urology and Pediatric Surgery, University of Michigan, Ann Arbor, USA.
Insights
High-grade vesicoureteral reflux significantly increases the risk of ureteropelvic junction obstruction in pediatric patients. Treatment outcomes vary, with many requiring surgical intervention for these urological conditions.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Outcomes
Background:
- Ureteropelvic junction obstruction (UPJO) and vesicoureteral reflux (VUR) are common pediatric urological conditions.
- Investigating the association between these conditions is crucial for understanding disease progression and optimizing treatment.
Purpose of the Study:
- To investigate the association between ureteropelvic junction obstruction and concomitant vesicoureteral reflux in pediatric patients.
- To evaluate treatment options and outcomes for patients diagnosed with both conditions.
Main Methods:
- Retrospective analysis of 6,790 pediatric urology records.
- Categorization of treatment options including observation, pyeloplasty, ureteroneocystostomy, and nephroureterectomy.
- Assessment of hydronephrosis, reflux, and obstruction resolution, improvement, or worsening.
Main Results:
- A significant association was found between high-grade VUR and UPJO (OR 5.0).
- No increased risk of UPJO was observed with low or intermediate-grade VUR.
- Treatment outcomes showed high rates of resolution or improvement for hydronephrosis (83%) and obstruction (100%) after pyeloplasty, though 35% required subsequent ureteroneocystostomy.
Conclusions:
- High-grade VUR is a risk factor for UPJO in children.
- While observation may be suitable for some, surgical intervention like pyeloplasty or nephrectomy is frequently required.
- Primary ureteroneocystostomy did not prevent the need for subsequent pyeloplasty in this cohort.
Purpose:
We investigated the association, treatment options and outcomes of patients with ureteropelvic junction obstruction and concomitant vesicoureteral reflux.
Materials And Methods:
We analyzed 6,790 consecutive pediatric urology records at our university. Treatment options included observation, and primary pyeloplasty, ureteroneocystostomy and nephroureterectomy. Hydronephrosis, reflux and obstruction were judged as resolved, improved, unchanged or worse.
Results:
A total of 1,140 patients had vesicoureteral reflux, 224 had ureteropelvic junction obstruction and 41 had both conditions (39 ipsilateral and 6 contralateral kidneys). There was no increased risk of obstruction in patients with reflux when all grades of reflux were grouped (odds ratio 1.26, confidence interval 0.91 to 1.71). In contrast, subgroup analysis of patients with high grade reflux demonstrated a 5-fold increased risk of obstruction (odds ratio 5.0, confidence interval 2.4 to 10.8). One patient was lost to followup. Observation of 6 kidneys led to resolution of reflux in 3 (50%), resolution of obstruction in 3 (50%) and resolution or improvement of hydronephrosis in 4 (67%). Primary pyeloplasty was done on 29 kidneys with 10 (35%) requiring subsequent ureteroneocystostomy. At latest followup hydronephrosis resolved or improved in 24 patients (83%), vesicoureteral reflux resolved or improved in 19 (66%) and ureteropelvic junction obstruction resolved in all. Primary ureteroneocystostomy was performed on 5 kidneys, all of which required subsequent pyeloplasty. Hydronephrosis resolved in 3 patients (60%), and reflux and obstruction resolved in all. Two patients treated with primary nephroureterectomy, and 1 who underwent concomitant pyeloplasty and ureteroneocystostomy have had no subsequent urological problems. One patient awaits primary pyeloplasty.
Conclusions:
High grade vesicoureteral reflux is associated with ureteropelvic junction obstruction. No association with low or intermediate grade reflux was demonstrated. While some patients may be monitored expectantly, in our series pyeloplasty or nephrectomy was required in 81% and ureteroneocystostomy was required in 36%. In no case did primary ureteroneocystostomy protect against the subsequent need for pyeloplasty.