Ureteroneocystostomy for Vesicoureteral Reflux in Children

Yoon, Jang Sup; Woo, Young Nam

Abstract

The deleterious effects of infected urine refluxing into the collecting system are well documented. The resultant renal scarring, parenchymal atrophy and interference with renal growth and function are recognized sequela that may profoundly affect the future of these children. Prevention of reflux nephropathy depends upon early identification off reflux and appropriate management with continuous antibiotic chemoprophylaxis or surgical correction. The ultimate goal of therapy for vesicoureteral reflux, whether medical or surgical , aims at protecting the kidney from scarring, improving the pre-existing renal function and allowing the fulfillment of renal growth potential. We report 11 patients(19 kidneys) with vesicoureteral reflux treated with ureteroneocystostomy during the past 4 years. Follow-up over 3 months was possible in 9 patients who have had no evidence of recurrent pyelonephritic episodes. In 9 patients(15 ureters), performed postoperative I.V.P. and V.C.U.G., reflux was disappeared in 8(14 ureters) and still persisted in only 1(1 ureter) with grade I. And 13 kidneys have been improved radiographically, but 2 which had been shown unilateral atrophy and contralateral compensatory hypertrophy, have not been changed postoperatively. Renal scarring in 8 kidneys(42%), associated with severe reflux(more than grade IV) and infection, have not been improved postoperatively, but the development of new scars and the progression of established scars have not been observed.