- Complication of intravesical correction of vesicoureteral reflux in children
Complication of intravesical correction of vesicoureteral reflux in children
Paediatric Surgery.2017.4(57):72-79; doi 10.15574/PS.2017.57.72
Nakonechnyy R. A., Prytula V. P., Nakonechnyі A. І.
Danylo Halytsky Lviv National Medical University, Ukraine
Bogomolets National Medical University, Kyiv, Ukraine
Objective. To reduce the percentage of complications in children after intravesical correction of VUR.
Material and methods. The clinical material covers 270 patients with uni- and bilateral VUR II-IV grades, aged from 9 months to 14 years. Patients with VUR were collected complaints and anamnesis, a clinical examination, general clinical laboratory examinations with an assessment of the functional status of the glomerular apparatus and the degree of nephrosclerosis, ultrasound of the urinary tract and bladder with Doppler effect, retrograde cystography, excretory urography, dynamic angiography and renography with 99mTc-DTPA, cystoscopy. At the stage of clinical and laboratory remission patients underwent intravesical restored urodynamics – STING (subureteric injection), HIT (hydrodistention implantation technique), Double HIT, and, if necessary, their combination.
Results. In the early postoperative period 8 (2.96%) patients had a disorder of urodynamics with exacerbation of pyelonephritis, requiring more intensive and prolonged parenteral antibiotic therapy – more than 3 days. In 4 patients a dilatation of the ureter and pyelocaliceal system (PCS) with signs of urinary tract obstruction was revealed via the ultrasonography. These patients performed an intravesical internal stenting of ureter and PCS with JJ-stent for 1-3 months. In 2 patients in the late postoperative period an obstructive ureterohydronephrosis was diagnosed according to the urological X-ray examination, which required the ureterocystoneostomy. The clinical case of minimally invasive removal of concrement fragments from the left ureter after intravesical treatment of VUR III grade in both segments of the left double kidney in a 3-year-old patient, who was twice operated and the defect was successfully corrected. Obstructive uropathy after the injection of implant under the urethra orifice is the results of neuromuscular dysplasia of the urinary tract, which associated with fibrous tissue changes in the area of the uretero-vesical junction.
Conclusions. The endoscopic method is the most optimal way of treating VUR in children and its complications. However, intravesical treatment of VUR, as well as other methods of surgical intervention, also has various complications.
Key words: vesicoureteral reflux, intravesical intervention, surgery complications, children.