Management of coexisting vesicourethral reflux and ureteropelvic junction obstruction in children

Abstract

Objective To explore the association, treatment options and outcomes of patients with ureteropelvic junction obstruction (UPJO) and concomitant vesicourethral reflux (VUR). Methods We reviewed the clinical records of 5 children with UPJO and concomitant VUR at our hospital between January 2011 and December 2012. Presentations included prenatal hydronephrosis, urinary tract infection (UTI) and renal retardation. The diagnosis of UPJO was based on ultrasonography and diuretic renography. Voiding cystourethrography was performed in all patients to detect vesicourethral reflux. Two patients underwent concomitant pyeloplasty and ureteroneocystostomy (Lich Gr goir repair). One patient underwent heterochronic pyeloplasty plus ureteroneocystostomy. One patient with low-grade VUR had pyeloplasty and the symptoms disappeared 6 months later. And another patient of laparoscopic pyeloplasty was followed up. Results All symptoms improved or disappeared. And renography showed better renal functions and excretion curves. Conclusions The coexistence of UPJO and VUR may be attributable to a single developmental abnormality. And UPJO is probably due to ureteral kinking and inflammation caused by VUR. Voiding cystourethrography is routinely recommended for detecting VUR in children with UPJO. The indications for voiding cystourethrography in children with UPJO should be limited to those with dilated ureters, UTI and renal retardation. High-grade reflux coexisting with UPJO requires pyeloplasty and ureteroneocystostomy. Low-grade reflux coexisting with UPJO may be managed with initial pyeloplasty and subsequent medical observations. Key words: Hydronephrosis; Vesicoureteral reflux; Abnormalities