Child ; Humans ; Vesico-Ureteral Reflux ; therapy

No abstract available.
Dextrans/*therapeutic use ; Female ; Humans ; Hyaluronic Acid/*therapeutic use ; Male ; Urinary Tract Infections/*epidemiology ; Vesico-Ureteral Reflux/*drug therapy

Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Infant ; Male ; Prognosis ; Retrospective Studies ; Treatment Outcome ; Vesico-Ureteral Reflux ; diagnosis ; therapy

PURPOSE: The development of contralateral reflux after successful unilateral antireflux surgery has led to controversy regarding etiology. Our aim was to analyze the incidence of newly developed contralateral reflux after successful unilateral Cohen's reimplantation in patients with grade III and IV reflux and to explain the postoperative trigonal distortion responsible for new contralateral reflux with case-control study. MATERIALS AND METHODS: We compared the incidence and outcome of contralateral reflux between the medical group with prophylactic antibiotics and the surgical group with unilateral Cohen's reimplantation in patients with unilateral vesicoureteral reflux. We retrospectively reviewed the records of 84 children seen in a 17-year period who had grade III (48 patients) and IV (36 patients) primary unilateral vesicoureteral reflux. Unilateral Cohen's reimplantation was done in 48 patients and prophylactic chemotherapy was done in 36 patients. RESULTS: Overall contralateral reflux developed in 13.8% of patients who underwent medical treatment and 14.6% of patients who underwent unilateral Cohen's reimplantation. In patients with grade III reflux, 13% of patients with medical treatment and 12% of patients with unilateral Cohen's reimplantation had contralateral reflux. Twelve patients with contralateral reflux had grade I (7 patients) and grade II (5 patients) reflux and resolved spontaneously within 18.2 months. CONCLUSIONS: The likelihood of trigonal distortion as the etiology of contralateral reflux is low given the similar incidence in cross-trigonal Cohen's reimplantation group and medical group with prophylactic chemotherapy in patients with grade III and IV primary vesicourerteral reflux.
Anti-Bacterial Agents ; Case-Control Studies* ; Child ; Drug Therapy ; Humans ; Incidence ; Replantation* ; Retrospective Studies ; Vesico-Ureteral Reflux*

PURPOSE: Many pediatric urologists still favor using prophylactic antibiotics to treat children with vesicoureteral reflux (VUR). However, breakthrough infection sometimes occurs, leading to significant increases in morbidity as a result of renal scarring. Therefore, we tested whether abnormal renal scan and other factors are predictive of breakthrough infection using univariate analyses. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 163 consecutive children who were diagnosed with vesicoureteral reflux between November 1997 and June 2010. Clinical parameters for the statistical analysis included form of presentation, gender, age, VUR grade, laterality, presence of intrarenal reflux, class of antibiotic drug, and presence of abnormal renal scan by Dimercapto-succinic acid. Clinical parameters used for prognostic factors were established by univariate analyses. Fisher's exact test and unpaired t-test were done using SPSS software [SPSS ver. 12.0 (SPSS Inc., Chicago, IL, USA)]. RESULTS: Breakthrough infection developed in 61 children (48.0%). A total of 58 children (45.7%) had abnormal renal scans. Time to development of breakthrough infection was significantly longer in girls (9.0+/-8.2 months) than in boys (5.8+/-4.8 months, p<0.05). On univariate analysis, though statistically not significant, the most predictive factor of breakthrough infection was abnormal renal scan (p=0.062). In patients with abnormal renal scans, breakthrough infection was not associated with mode of presentation, gender, grade or prophylactic antibiotics. However, there was a significant difference between patients younger than 1 year and those 1 year old or older. Mean+/-SD age at diagnosis of VUR in patients with breakthrough infection (1.14+/-3.14) was significantly younger than in those without breakthrough infection (5.05+/-3.31, p=0.009). There was also a significant difference between patients with bilateral or unilateral reflux (p=0.028). CONCLUSION: Our data showed that abnormal renal scan was the most predictive factor of breakthrough infection and demonstrated statistical significance in patients under the age of 1 year. Parents and physicians should remain aware that these patients are at high risk of breakthrough urinary tract infection, which may potentially lead to renal damage.
Anti-Bacterial Agents/*therapeutic use ; Female ; Humans ; Infant ; Male ; Retrospective Studies ; Urinary Tract Infections/*drug therapy/etiology ; Vesico-Ureteral Reflux/complications/*drug therapy/*microbiology

OBJECTIVE: Endoscopic correction of vesicoureteral reflux has evolved as a viable alternative to open surgery. This study was conducted to review the experience of a single institution with the endoscopic Deflux procedure and assess its effectiveness in the treatment of vesicoureteral reflux.

MATERIALS AND METHODS: A retrospective review of patients who underwent endoscopic Deflux treatment for primary vesicoureteral reflux (VUR) between January 2005 and December 2010 was performed. Data collected included: age, gender, unilateral or bilateral treatment, pre-operative grade of VUR on voiding cystourethrogram (VCUG), and the number of Deflux injections per patient.

RESULTS: Sixteen patients [7 (43.75%) males and 9 (56.25%) females] were included in this study. The ages ranged from 6 months to 8 years old with a mean age of 3.15 years. Four (25%) patients had bilateral VUR while 12 (75%) had unilateral VUR, with a total of 21 refluxing ureters. Three had Grade II reflux (14.3%), 13 had Grade III reflux (62%), 5 had Grade IV reflux (24%), and 1 had Grade V reflux (4.7%). Nineteen ureters required one injection while one ureter required two injections. There were no intraoperative nor postoperative complications noted.

CONCLUSION: At the National Kidney and Transplant Institute, endoscopic treatment of VUR with Deflux for primary VUR demonstrated a cure rate of 90%, with no associated perioperative morbidity.

Human ; Male ; Female ; Child ; Child Preschool ; Infant ; deflux ; Endoscopy ; Vesico-Ureteral Reflux-treatment, therapy, management, drug therapy ; Urinary Bladder Diseases ; dextranomer ; dextranomer-hyaluronic acid copolymer

During the lest 7 years 21 children with vesicoureteral reflux and neurogenic bladder dysfunction and 46 children with primary vesicoureteral reflux were followed. At the time of initial presentation, the mean age of the former group was 5.5 years and the letter group, 2.8 years. The grade of reflux and the nephropathy were more severe in the children with neuropathic bladder than in the children with primary vesicoureteral reflux But in the same reflux grade, there was no statistical difference in the nephropathy between the two groups. The children with vesicoureteral reflux and neuropathic bladder were managed with drug therapy, intermittent catheterization, urinary diversion and ureteral reimplantation. Radiological followup revealed that resolution or improvement of reflux occurred in 36 per cent of renal units managed by intermittent catheterization and 100 per cent in which the ureters were reimplanted. As in the non-neurogenic bladder successful management of reflux and prevention of upper tract deterioration can be achieved by conservative management as well as by ureteroneocystostomy.
Catheterization ; Catheters ; Child* ; Drug Therapy ; Follow-Up Studies ; Humans ; Replantation ; Ureter ; Urinary Bladder ; Urinary Bladder, Neurogenic* ; Urinary Catheterization ; Vesico-Ureteral Reflux*

During the lest 7 years 21 children with vesicoureteral reflux and neurogenic bladder dysfunction and 46 children with primary vesicoureteral reflux were followed. At the time of initial presentation, the mean age of the former group was 5.5 years and the letter group, 2.8 years. The grade of reflux and the nephropathy were more severe in the children with neuropathic bladder than in the children with primary vesicoureteral reflux But in the same reflux grade, there was no statistical difference in the nephropathy between the two groups. The children with vesicoureteral reflux and neuropathic bladder were managed with drug therapy, intermittent catheterization, urinary diversion and ureteral reimplantation. Radiological followup revealed that resolution or improvement of reflux occurred in 36 per cent of renal units managed by intermittent catheterization and 100 per cent in which the ureters were reimplanted. As in the non-neurogenic bladder successful management of reflux and prevention of upper tract deterioration can be achieved by conservative management as well as by ureteroneocystostomy.
Catheterization ; Catheters ; Child ; Drug Therapy ; Follow-Up Studies* ; Humans ; Replantation ; Spinal Cord Injuries* ; Spinal Cord* ; Ultrasonography* ; Ureter ; Urinary Bladder ; Urinary Bladder, Neurogenic ; Urinary Catheterization ; Vesico-Ureteral Reflux

During a 6 year period from 1979 to 1984, we examined 35 children with neuropathic bladder At the time of their initial presentation, incontinence was the most frequent symptom (66%) and urinary tract infection was present in 63% azotemia 7% upper tract dilatation 50% vesicoureteral reflux 55% Functional classification based on urodynamical assessment and clinical findings showed 21 patients (60%) with emptying failure and 14 patients (40%) with storage failure. The incidence of upper tract dilatation and urinary tract infection was significantly higher in patients With emptying failure than those with storage failure. These patients were managed with drug therapy, intermittent catheterization and urinary diversion and their follow-up observations are discussed.
Azotemia ; Catheterization ; Catheters ; Child ; Classification ; Dilatation ; Drug Therapy ; Follow-Up Studies ; Humans ; Incidence ; Urinary Bladder, Neurogenic* ; Urinary Diversion ; Urinary Tract Infections ; Vesico-Ureteral Reflux

PURPOSE: Endoscopic treatment (ET) has become a widely accepted procedure for treating vesicoureteral reflux (VUR). However, patients followed up after ET over long periods have reported persistent or recurrent VUR. We evaluated the natural course of failed ET in patients who required further treatments to help physicians in making decisions on the treatment of VUR. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients who were diagnosed with VUR and underwent ET from January 2006 to December 2009. A total of 165 patients with 260 ureters underwent ET. We compared the parameters of the patients according to ET success or failure and evaluated the natural course of the patients after ET failure. RESULTS: Mean VUR grade and positive photon defect were higher in the failed ET group than in the successful ET group. Six months after the operation, persistent or recurrent VUR was observed in 76 ureters (29.2%), and by 16.3 months after the operation, VUR resolution was observed in 18 ureters (23.7%). Twenty-five ureters (32.9%) without complications were observed conservatively. Involuntary detrusor contraction was found in 1 of 9 (11.1%) among the secondary ET success group, whereas in the secondary ET failure group, 4 of 6 (66.7%) had accompanying involuntary detrusor contraction. CONCLUSIONS: Patients in whom ET fails can be observed for spontaneous resolution of VUR unless they have febrile urinary tract infection or decreased renal function. Urodynamic study may be helpful in deciding whether a secondary procedure after ET failure is necessary.
Child ; Child, Preschool ; *Cystoscopy ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Muscle, Smooth/*physiopathology ; Retrospective Studies ; Treatment Failure ; Treatment Outcome ; Urinary Bladder/*physiopathology ; *Urodynamics ; Vesico-Ureteral Reflux/*therapy