Téma: 

Conservative vs. surgical treatment of primary vesicoureteral reflux in children

Zuzana Kurcinová, Ladislav Valanský, Richard Bartl, Ľudmila Podracká, Eva Sádová, Tatiana Baltésová

Objective: Indications for surgical treatment of primary vesicoureteral reflux (PVUR) are still controversial. The aim of the retrospective study was comparison of the results of conservative and surgical treatment of PVUR in own clinical material. Material and Methods: In the period of 1990 - 2006, 270 children (75 M, 195 F), at the time of diagnosis aged 3 months to 14.9 yrs (avg. 5.2 yrs.) have been treated for PVUR (297 ureters). PVUR of grades III and IV prevailed (126/46.8 % vs. 85/31.6 %). All children were initially under observation with concomitant prophylactic antibiotic treatment lasting for 3 - 53 months (mean period - 12 months). Surgically were treated 146 (54 %) children at age of 12 months in average (7 months to 14.9 yrs). Indications for surgery were persisting VUR with recurrent UTI and/or occurrence of kidney scars on DMSA scan, respectively. Results: Conservative treatment has led to resolution of PVUR in 124 (46 %) children, with grade I - II in 100 %, grade III in 20.2 %, grade IV in 6.4 %. Resolution of VUR (n 270) was observed in the first, second and third year of life in 39 (14.4 %), 14 (5.2 %) and 71 (26.3 %) children, respectively. Surgery (most frequently ureteral re-implantation sec. Paquin and Lich-Gregoir) resulted in VUR elimination in 98 %. Out of 8 re-operations, 3 re-implantations were indicated for ureteral strictures, 5 because of persisting VUR. Recurrent UTI during conservative treatment occurred in 150 (59.3 %) children out of which 112 (41.5 %) presented with acute pyelonephritis unlike of only 4 (2.7 %) cases after surgical treatment. Kidney scars on DMSA scintigraphy were present preoperatively in 93 (63,7 %) children (with grade III in 27 %, grade IV in 69.4 %). Because of gross kidney damage 5 (3.4 %) nephrectomies were indicated. Conclusions: PVUR represents a significant congenital anomaly with limited effect of conservative treatment especially if grade II is exceeded. Based on patients´ age and frequent occurrence of kidney scars at the time of surgery it can not be excluded that one of the risk factors of reflux nephropathy is delayed indication of surgical treatment of PVUR.

Ročník 2007  Témy časopisu Clinical urology 3 / 2007

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