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Predictors of surgical outcome in children with vesicoureteral reflux associated with paraureteral diverticula.

Artikel i vetenskaplig tidskrift
Författare Özgu Aydogdu
Berk Burgu
Tarkan Soygur
Publicerad i Urology
Volym 76
Nummer/häfte 1
Sidor 209-14
ISSN 1527-9995
Publiceringsår 2010
Publicerad vid Institutionen för neurovetenskap och fysiologi, sektionen för farmakologi
Sidor 209-14
Språk en
Länkar dx.doi.org/10.1016/j.urology.2009.1...
www.ncbi.nlm.nih.gov/entrez/query.f...
Ämnesord Adolescent, Child, Child, Preschool, Diverticulum, complications, surgery, Female, Humans, Infant, Male, Prognosis, Retrospective Studies, Ureteral Diseases, complications, surgery, Vesico-Ureteral Reflux, etiology, surgery
Ämneskategorier Pediatrik, Njursjukdomar, Urologi och njurmedicin, Urologi och andrologi, Klinisk medicin

Sammanfattning

To retrospectively evaluate success rates of different surgical approaches in the treatment of paraureteral (Hutch) diverticula (PUD) associated with vesicoureteral reflux (VUR) and also to define preoperative objective criteria to predict the surgical outcome.Records of 51 patients who underwent surgical treatment for PUD were reviewed. Intravesical ureteroneocystostomy (UNC), subureteral injection, and extravesical UNC were performed in 23, 28, and 10 renal units, respectively. Records of patients were evaluated with particular emphasis on predictors of treatment outcome. Mean follow-up was 22.1 months (range, 3-46). Statistical significance was set at P <.05.Overall success rates were 91%, 79%, and 80% for intravesical UNC, subureteral injection, and extravesical UNC, respectively (P >.05). The mean PUD index for patients who underwent endoscopic treatment was significantly lower (P <.05). In the endoscopic group, reflux was detected at the late-filling or voiding phase of voiding cystourethrography (P <.005). In patients, who were diagnosed with video urodynamics, reflux began at higher bladder pressures and volumes in the injection group (P <.005). UNC was more frequently used in patients with the orifice at the neck or dome (P <.005).For injection in the lower PUD index, onset of reflux at late-filling or voiding phase on voiding cystourethrography, higher pressure and volume on video urodynamics, and C position orifice are positive predictive parameters for success. Bilateral reflux with high PUD index and grade 5 VUR are associated with failure of intravesical reimplantation. Presence of grade 5 VUR and an early onset of reflux outstand as negative predictive factors for unilateral extravesical UNC.

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