MEHMET NURİ CEVİZCİ, SONER SERTAN KARA, Alev Cansu AYAN, Abdulkadir KAYA, Hediye CEVİZCİ

A 5-year retrospective analysis of patients with primary vesicoureteral reflux undergoing open surgery; an assessment of 60 patients

Vesicoureteral reflux (VUR) describes the backward flow of urine from the bladder to the ureter and/or kidney. In this study, 60 patients below 18 years of age diagnosed with primary VUR in our clinic between 2010 and 2014 and undergoing ureteroneocystotomy using various open surgery techniques were evaluated retrospectively. Diagnosis of VUR was based on voiding cystourethrography (VCUG). Urinary system ultrasonography (USG) was performed to exclude possible additional pathologies and to monitor the clinical course. Static renal scintigraphy (DMSA) was perform ed to determine preoperative renal scars and loss of function. Severity of reflux was divided into 5 degrees following the criteria set out by the International Reflux Study Group. Patients were divided into 3 groups, mild , moderate (grade 3) or severe VUR. Females constituted 71.7% of the patients (n=43). Mean age at time of diagnosis of VUR was 6.25 years and mean age at time of surgery was 6.36 years. Fifteen percent of VURs were on the right side (n=9), 31.7% were on the left side (n=19) and 53.3% were bilateral (n=32). Advanced grade VUR was determined in 68.3% of patients. Loss of function was observed in 27.7% (n=16) of patients undergoing DMSA, and scar and loss of function were determined in 46.7% (n=28). The most common pathogen grown in preoperative urine cultures was Escherichia coli (65%). No significant difference was observed between the VUR grades in terms of age at time of diagnosis or age at time of surgery (p=0.682 and p=0.673, respectively). No statistically significant correlation was also determined between gender and VUR grade (p=0.859). No patient required a second surgical procedure. At postoperative follow-up, hypertension was observed in two patients, and these received antihypertensive therapy. Hypertension was observed over the long-term in one patient and was controlled with antihypertensive therapy. In conclusion, a high level of loss of renal function and scars was determined, in parallel with greater age at time of diagnosis of VUR and at time of surgery, in our region

PDF

___

Kincaid-Smith P, Becker G. Reflux nephropathy and chronic atrophic pyelonephritis: a review. J Infect Dis. 1978;138(6):774- 80.

Gökçe İ. Renal parenkimal skar ve reflü nefropatisi. Turk Neph Dial Transpl 2012;21(1):21-7.

Burger R, Smith C. Hereditary and familial vesicoureteral reflux. J Urol. 1971;106(6):845-51.

Van den Abbeele AD, Treves ST, Lebowitz RL, Bauer S, Davis RT, Retik A, et al. Vesicoureteral reflux in asymptomatic siblings of patients with known reflux: radionuclide cystography. Pediatrics. 1987;79(1):147-53.

Nakai H, Kakizaki H, Konda R, Hayashi Y, Hosokawa S, Kawaguchi S, Matsuoka H, Nonomura K, Shimada K, Kawamura T. Clinical characteristics of primary vesicoureteral reflux in infants: multicenter retrospective study in Japan. J Urol. 2003;169(1):309-12.

Blickman J, Taylor G, Lebowitz R. Voiding cystourethrography: the initial radiologic study in children with urinary tract infection. Radiology. 1985;156(3):659-62.

Ali E-TM, Alfaki EM, Abdelraheem MB. Primary vesicoureteral reflux in Sudanese children. Saudi J Kidney Dis Transpl. 2014;25(4):900-5.

Dillon MJ, Goonasekera C. Reflux nephropathy. J Am Soc Nephrol. 1998;9(12):2377-83.

Elder JS, Peters CA, Arant BS, Ewalt DH, Hawtrey CE, Hurwitz RS, et al. Pediatric Vesicoureteral Reflux Guidelines Panel summary report on the management of primary vesicoureteral reflux in children. J Urol. 1997;157(5):1846-51.

Willi U, Treves S. Radionuclide voiding cystography. Pediatric nuclear medicine: Springer; 1985;105-20.

Weiss R, Duckett J, Spitzer A. Results of a randomized clinical trial of medical versus surgical management of infants and children with grades III and IV primary vesicoureteral reflux (United States). The International Reflux Study in Children. J Urol. 1992;148(5 Pt 2):1667-73.

Callaghan K, Gray E, Caldamone A, Ellsworth P. Factors involved in parental decision making for surgical correction of vesicoureteral reflux. J Urol. 2008;180(2):701-6.

Huang F-Y, Tsai T-C. Resolution of vesicoureteral reflux during medical management in 1995;9(6):715-7.

children. Pediatric Nephrology.

Peters C, Rushton HG. Vesicoureteral reflux associated renal damage: congenital reflux nephropathy and acquired renal scarring. J Urol. 2010;184(1):265-73.

Gordon A, Thomas D, Arthur R, Irving H, Smith S. Prenatally Diagnosed Reflux: a Follow-up Study. Br J Urol. 1990;65(4):407- 12.

Anderson P, Rickwood A. Features of primary vesicoureteric reflux detected by prenatal sonography. Br J Urol. 1991;67(3):267- 71.

Skoog SJ, Belman AB, Majd M. A non surgical approach to the management of primary vesicoureteral reflux. J Urol. 1987;138(4 Pt 2):941-6.

Tekgül S, Riedmiller H, Hoebeke P, Kocvara R, Nijman RJ, Radmayr C, Stein R, Dogan HS. EAU guidelines on vesicoureteral reflux in children. Eur Urol. 2012;62(3):534-42.

Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011;128(3):595-610.

McLorie G, McKenna P, Jumper B, Churchill B, Gilmour R, Khoury A. High grade vesicoureteral reflux: analysis of observational therapy. J Urol. 1990;144(2 Pt 2):537-40.

Connolly LP, Treves ST, Connolly SA, Zurakowski D, Share JC, Bar-Sever Z, Mitchell KD, Bauer SB. Vesicoureteral reflux in children: 1997;157(6):2287-90. severity in siblings. J Urol.

Cenk A, Gürocak S. Vezikoüreteral reflüde güncel yaklaşımlar ve tedavi alternatifleri. Turkiye Klinikleri J Pediatr. 2010;19(1):38-46.

Kılıç N. Çocuklarda vezikoüreteral reflü. Turk Pediatri Ars. 2010;80-4.