engleski

Our results in treatment of vesicoureteral reflux: comparison of methods and long-term follow-up

Introduction VUR is a common urological anomaly in children, defined as adverse return of urine from the bladder to ureter or the renal pelvis and the calyces. Primary reflux (PVUR) is congenital anomaly of ureter and bladder junction with genetic background while secondary reflux (SVUR) is usually associated with anatomical and functional obstruction in the urinary bladder. Besides conservative treatment, VUR can be dealt surgically, in recent years increasingly using endoscopic techniques. The purpose of this retrospective study is to analyze our patients, clinical presentation, diagnostic procedures and results of treatment. Patients and Methods From 1984 to 2009 a total of 140 patients with VUR have been treated at our clinic, 129 female and 11 male patients. PVUR was found in 127 patients (age 6 months-16 years) while secondary in 13 patients (age 17-49 years). In 27 patients with PVUR other morphological or functional abnormality of lower and upper urinary tract was found, most common were: double ureter (16), ureter stenosis (4) and neurogenic bladder (3). Positive family history was found in 11 patients. Most commonly used operation technique in PVUR was Lich-Gregoir and for SVUR Politano-Leadbetter. From 2002 we started with endoscopic treatment with instillation of bulking agents. VUR had been unilateral in 116 patients (44 on the right side, 72 on the left), and bilateral in 24 patients. Recurrent acute pyelonephritis was detected in 99 patients and bacteria were isolated from urine culture in 51 patients. Other patients with clear clinical symptoms of pyelonephritis had sterile urine, but all were under antibiotic therapy before taking a urine sample. Voiding cystography was done in the all patients. In 59 patients we found active VUR and in the remaining 81 patients cystography revealed passive VUR. Results Of all treated patients 128 had excellent results and were discharged on the 11th to the 13th day after surgery, or the 2nd to 3rd day after the installation of bulking agents. In 2 patients with PVUR secondary operation had to be done due to ureteral fistulas and in 1 due to ureteral obstruction. In 2 patients with bulking agents instillation, another installation was needed. The success rate for open surgery is 97, 6% and the success rate of endoscopic surgery was 80%. Discussion The diagnosis of VUR should be set as early in childhood with PVUR and in the adult population that is often associated with SVUR, in order to avoid damage of renal function. The VUR should always be suspected in recurrent pyelonephritis and pathologic findings of urine in children. The success rate of surgical and endoscopic procedures in our institution was comparable to success rate of previously published studies.

vesicoureteral ; reflux ; treatment

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