Treatment of neuromuscular dysplasia of the vesicoureteral segment of the ureters in children

Abstract

Aim. To optimize conservative and surgical treatment of neuromuscular dysplasia of the vesicoureteral segment in children.Materials and methods. Study included 84 operated children with neuromuscular dysplasia of the vesicoureteral segment of the ureters. Megaureter antenatally diagnosed in 28 (25.4%) children: Ι degree - in 5, II degree - in 9, III degree - in 10, IV degree - in 4 children. The main criteria for diagnosing a megaureter in the perinatal period are an expansion of the anterior-posterior size of the pelvis, visualization of the dilated ureter, and in СFM - identification of weakening of the renal blood flow in the affected side.Results and discussion. As a result of the conservative and minimally invasive therapy – stenting of the ureters for up to 2 years, urodynamics were restored and the phenomena of ureterohydronephrosis were eliminated in 30 (27.2%) patients. In 32 (29%) patients, percutaneous puncture nephrostomy was performed, aimed at reducing the collecting system of the kidney, and ureter, as well as preparing for surgical treatment. The operated patients (84) were divided into 3 groups: Group I - operated according to the Politano-Ledbetter method (29); Group II - according to Cohen (20); Group III operated according to the method of extravesical reimplantation of the ureter with antireflux protection, developed in the clinic of pediatric surgery (35). Complications were noted in 8 (27.5%) patients after the Politano-Ledbetter operation; in 4 (20%) cases after the Cohen method operation; and in 5 (14.2%) cases after the extravesical reimplantation with antireflux protection.Conclusion. The method of ureteral reimplantation, developed and tested at the Clinic of Pediatric Surgery, is a fairly effective way to treat megareteral disease in children. This technique is highly effective in children older than 1-3 years, which makes 85.8%.