[Intermittent vesico-ureteral reflux in children].
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Biomedical subjects
Publications and source records attributed to N G Moskaleva.
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Extravesical ureterocystoanastomosis without wide opening of the urinary bladder was practised since 1986. A total of 79 patients were operated: 71 children at the age from 1 to 14 years and 8 adults aged 14 to 58 years. Surgical intervention was performed on 112 ureters for vesicoureteral reflux and supravesical ureteral obstruction. 6 of 79(7.6%) patients on postoperative day 11-15 after removal of intubating drains had an attack of acute pyelonephritis. 3 of these 6 patients were reoperated with a good effect, in 2 patients urine passage recovered 2-3 months after removal of transcutaneous puncture nephrostoma. In one child this technique was used for the first time at the third operation on vesicoureteral anastomosis. This prevented subsequent removal of the nephrostomic drain because of vesicoureteral reflux in the presence of severe irreversible retention changes of both ureters. The advantages of the above technique are reduced operative injury, no contraindications in primary operations and reoperations, feasibility in various forms of vesicoureteral anastomosis failure. This makes the technique of extravesical ureterocystoanastomosis rather promising.
Basing on the results of a combined clinical and laboratory examination of 193 children treated in the Research Institute of Urology in 1992-1999, the authors studied causes underlying intermittent vesicoureteral reflux (IVR) in correlation with anatomo-functional changes in vesicoureteral anastomosis and severity of inflammation in the urinary bladder. They suggest a diagnostic algorithm of detecting IVR with assessment of gas cystography role in the diagnosis; give definition of IVR; describe therapeutic policy in accordance with functional state of the affected kidney and cause of IVR onset; analyse short- (6-12 months) and long-term (12-36 months) treatment results; outline methods of IVR prophylaxis to save and improve renal function.