[Status and development of the kidneys in the late periods after surgical treatment of vesico-renal reflux in children].
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Biomedical subjects
Publications and source records attributed to A L Cheskis.
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Fourteen organ-preserving operations were fulfilled for deep ruptures of kidneys in children aged from 2.5 to 14. The examination including echography and dynamic scintigraphy in addition to traditional methods has shown good reestablishment of functioning the damaged kidney. The authors believe the operative organ-preserving treatment to be expedient for deep ruptures of the kidney.
Kidney biopsies were examined in 73 children with some forms of obstructive uropathies: vesico-renal reflux and obstructive megaurether. In 59 patients (80%), chronic pyelonephritis was detected. The predominant morphological form of chronic pyelonephritis in patients with obstructive uropathies is a mixed form with a combination of tubulo-stromal-vascular changes. In most patients chronic pyelonephritis was extensive up to the development of nephrosclerosis, in 22% it developed against the background of renal dysplasia. The nature and intensity of pyelonephritis was shown to depend on the severity of congenital pathology of the urinary tracts and the age of the patients.
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Antireflux operations after the Grégoir-Lich technic was performed in 50 children on 72 ureters; resection of the distal ureteral portion with neoimplantation after the Politano-Leadbetter technic was accomplished in 31 patients on 46 ureters; nephroureterectomy-in 4 patients due to destruction of the organ. Morphological studies of 50 by the defect in development of muscles of the distal ureteral portion (diffuse, hyperplasia of muscle bundles, focal or segmental underdevelopment of muscles, etc). In insignificant muscle hypoplasia chronic inflammation resulting in sclerosis is of major importance for pathogenesis of insufficiency of the uretero-vesical segment. The changes described are manifested in the clinico-roentgenological picture of the disease. In reflux, grade III-IV, according to the R. A. Bridge and C. W. Roe classification resection and neoimplantation of the ureter after the Politano-Leadbetter technic seem to be indicated; in grade II antireflux Grégoir-Lich surgery may be performed.
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