Occurrence Of Vesicoureteral Reflux Research Articles

A Practical Technique for Challenging Ureterocystoneostomy : Application of Casale Vesicostomy with Rink-Modification

In order to treat the iatrogenic ureteral stricture of more than 8 cm length after transurethral ureterolithotripsy, we planned to perform ureterocystoneostomy with psoas hitch and Boari flap. Because of the longer defect of the affected ureter than presurgically expected and the rigid and thickened ureteral stump resulting from chronic inflammation, anti-reflux technique by forming submucosal tunnel could not be achieved as in the standard Boari flap and we reluctantly anastomosed the ureteral stump to the end of the tubularized bladder wall flap in end-to-end fashion. In order to secure the anti-reflux mechanism we created a submucosal tunnel in the posterior bladder wall according to the technique reported by Casale and Rink where it originally worked as anti-incontinence mechanism of catheterizable vesicostomy. The follow-up examinations showed no recurrence of ureteral stricture nor occurrence of vesicoureteral reflux.

Occurrence of vesicoureteral reflux among the antenatally detected urinary tract dilation/antenatal hydronephrosis

Occurrence of vesicoureteral reflux among the antenatally detected urinary tract dilation/antenatal hydronephrosis

Sonographic assessment of the effect of vesicoureteral reflux and urinary tract infections on growth of the pediatric solitary kidney

Perusal of recent guidelines relating to proper evaluation of infants and children with urinary tract infection (UTI) suggests that the occurrence of vesicoureteral reflux (VUR) may not have the clinical import previously ascribed to this anatomic abnormality. Patients with a solitary kidney uniquely allow investigation of the effects of both vesicoureteral reflux (VUR) and urinary tract infection (UTI) on renal growth unencumbered with the inevitable questions of laterality that confound analysis in patients with two kidneys. Several previous studies with conflicting results have addressed whether vesicoureteral reflux (VUR) impacts ultimate renal size in children with a solitary kidney. Few published studies have considered the occurrence of both urinary tract infection (UTI) and VUR on the degree of compensatory hypertrophy. This is the largest series to date investigating the effect of both UTI and VUR on the degree of compensatory hypertrophy with time. Our objective was to analyze sonographically determined renal growth in patients with a solitary kidney, stratifying for both the occurrence and severity of UTIs and the occurrence and severity of VUR. We retrospectively reviewed the clinical history (including bladder and bowel dysfunction (BBD)) and radiology reports of 145 patients identified as having either a congenital or acquired solitary kidney in our pediatric urology practice from the prior 10 years. UTIs were tabulated by severity, where possible, and the grade of VUR was recorded based on the initial cystogram. Sonographically determined renal length was tabulated for all ultrasounds obtained throughout the study. Based on a mixed-effects model, we investigated the influence of UTI and VUR on renal growth. Of the 145 patients analyzed, 105 had no VUR and 39 had VUR (16 = Gr I&II, 11 = GIII, 12 = GIV&V). Comparison showed that there was no difference in the occurrence of UTI between those without VUR (27/105 with UTI) and those with VUR (15/39 with UTI; p = 0.14). There was no difference in the occurrence of BBD in patients with VUR (15/39) and those without VUR (36/106, p = 0.62). While neither VUR nor UTI alone affected renal growth in the solitary kidney, the three-way interaction term among age, VUR, and UTI was significant (p = 0.016). The growth of the kidneys in the various patient groups is depicted in the table. From the analysis, a refluxing solitary kidney with UTI showed a significantly lower growth rate than the other groups (p < 0.001). This study is limited by the inherent selection bias of retrospective studies. Additionally, the variability of sonographic renal measurement is well recognized. Lastly, our sample size did not allow us to incorporate the severity of the UTIs and the grades of VUR in our final regression model. Nevertheless, the overall patterns suggest that when both VUR and UTI are present, the solitary kidney demonstrates less renal growth with time. Study of larger cohorts of patients with solitary kidneys will be necessary to confirm our observations and discern what, if any, are the consequences of high-grade VUR and upper tract UTI in these patients. In the largest series to date we were able to discern no independent effect of either VUR or UTI on sonographically determined renal growth in patients with a solitary kidney. However, UTI and VUR together result in kidneys that are smaller than other solitary kidneys not so affected. Follow-up studies of larger cohorts seem warranted to confirm these findings and discern the clinical import of these smaller kidneys.

Отеки у беременных: заболевание или норма?

During pregnancy the effects of a number of predisposing factors (influence of progesterone, a violation of the passage of urine, the occurrence of vesicoureteral reflux) often lead to exacerbation of chronic diseases of the urinary tract, the development of eye and preeclampsia. This has an adverse impact on the course of pregnancy and perinatal outcomes. The Multicenter study «Evaluation of efficacy, safety and tolerability of cranberry extract in soft capsules Iuravit (biologically active additive to food) for prophylaxis and complex therapy of urinary tract infections in women during pregnancy» in cases of 195 women showed high efficacy, tolerability, a small number of side effects (5,6% of women), and worsening of urinary tract infections in 4,6% (mostly due to a violation of the outflow of urine and indications for stenting ureters). It allows to recommend the use of cranberry extract Juravit as prophylaxis in pregnant women with diseases of the urinary tract.

Endoscopic treatment of ureterovesical junction obstructive pathology: A description of the oblique meatotomy technique and results

Benign obstructive pathology of the ureterovesical junction includes congenital and acquired illnesses. The objective of this study was to describe the endoscopic oblique meatotomy technique using scissors and cold cutting to treat benign obstructive pathology of the ureterovesical junction. From 2007 to 2012, we treated 18 patients with obstructive pathology of the ureterovesical junction (5 megaureters [3 with lithiasis], 4 iatrogenic stenoses, and 9 ureteroceles with lithiasis). In all cases, oblique meatotomy was performed using endoscopic scissors through an 8.5 Ch ureteroscope. The mean follow-up for all patients was 3 years. Pain, grade of hydronephrosis, and occurrence of vesicoureteral reflux were evaluated before and after treatment. The mean endoscopic treatment time was 13.4 minutes. The procedure was performed on an outpatient basis with 6 hours of hospital admission, and a double J stent was inserted for 6 weeks. We achieved treatment success in 94.5% of patients after 3 years of follow-up. Only 1 patient presented with vesicoureteral reflux at 12 months after treatment; however, this condition did not require further treatment. Overall, 100% of patients remained free from lithiasis. There are 2 main limitations: the small number of patients and the lack of another group to compare the results of this technique; however, the aim of this work was to communicate a new technique to treat ureterovesical junction stricture. Oblique ureteral meatotomy is a safe and effective treatment for benign obstructive pathology of the ureterovesical junction and has a low index of complications.

The frequency of vesicoureteral reflux diagnosis is correlated with urbanization level of residence in pediatric population: A nationwide study in Taiwan

ObjectiveTo investigate the frequency and characteristics of newly diagnosed vesicoureteral reflux (VUR) in children younger than 18 years based on a nationwide database in Taiwan. MethodsThe present study utilizes a subset of the Taiwan's National Health Insurance Research Database, known as the Longitudinal Health Insurance Database 2005, which contains the data of all paid medical benefit claims over 1997–2007 for a subset of 1,000,000 beneficiaries randomly drawn from the population of 22.72 million individuals during any part of the 2005 calendar year. Our analysis includes the data of all pediatric patients with the diagnosis of VUR. ResultsA total of 738 subjects with VUR diagnosis were identified, including 412 (55.8%) boys and 326 (44.2%) girls. The peak age of VUR occurrence was the first year for males and 1–4 years for females. Approximately 49.7% of all subjects presented with urinary tract infection (UTI); moreover, there were significant differences between genders concerning the presence of UTI (RR = 0.8; p = 0.002). The occurrence rate of VUR in the pediatric population ranged from 2.63 in 1998 to 3.94 in 2003 per 10,000 children during 1998–2005. The frequency of newly-diagnosed VUR in the pediatric population was significantly correlated with urbanization levels of residence. ConclusionThe nationwide, population-based study of pediatric VUR shows there were gender differences in age distribution and presence of UTI. Further studies are warranted to clarify the correlations between urbanization level of residence and occurrence of VUR.

First urinary tract infection in neonates, infants and young children: a comparative study

In an attempt to evaluate first urinary tract infection (UTI) in neonates and infants, we estimated retrospectively in 296 patients (62 neonates and 234 infants) clinical and laboratory findings, occurrence of vesicoureteral reflux (VUR), urinary tract abnormalities and pyelonephritis. First UTI occurred more often in male than female neonates, whereas male and female infants/young children were affected at an equal rate. The pathogens isolated in urine cultures of neonates and infants did not statistically significantly differ (P>0.05); Escherichia coli predominated. Gram-negative bacteria other than E. coli affected boys more often than girls (P=0.0022). Fever was the most frequent symptom. Neonates had lower-grade fever of shorter duration than infants (P<0.05). The incidence of reflux and urinary tract abnormalities did not differ between neonates and infants, male and female neonates and infants (P>0.05). Pyelonephritis affected neonates and infants at an equal rate; it was more prevalent among female patients (P=0.038) and patients with VUR or urinary tract abnormalities other than VUR (P<0.0001). Neonates with reflux were more often affected by Gram-negative bacteria other than E. coli than were neonates without reflux (P=0.0008).

Successful use of transureteroureterostomy in children: a clinical study.

The purpose of this review of patients was to look at the current role of transureteroureterostomy in children. In addition, this study should give an indication of the long-term safety of transureteroureterostomy in children with neurogenic bladder. From 1972 on, 70 subjects between the ages of 2 and 13 underwent transureteroureterostomy. In 68 patients (97 %), transureteroureterostomy was used as a salvage renal procedure after unsuccessful ureteroneocytostomy attempts at other institutions. In 2 patients (3 %), transureteroureterostomy was used as a diversion procedure. The postoperative course was uneventful except for 1 case of early anastomotic occlusion successfully treated by application of a double-J stent. No patient required surgical revision of the ureteral anastomosis. However, 4 patients with neurogenic bladder from myelomeningocele developed sequelae. Of these, 1 presented with stenosis at the end of the recipient ureter, 2 had occurrence of vesicoureteral reflux in nonreimplanted recipient ureter, 1 developed calculi in the donor pelvis. This study supports the view that transureteroureterostomy is highly useful for the management of children with a wide spectrum of urological anomalies. However, long-term monitoring of patients with neurogenic bladder who have undergone this procedure is essential to achieve a long-term good outcome.

Blind-ending bifid ureters--report of five pediatric cases.

We report 5 cases of blind-ending ureters according to Culp's criteria. Occurrence of vesicoureteral reflux allowed us to make the diagnosis of retrograde cystography in all our patients. We wish to emphasize that this procedure must be done as the first step of urinary tract examination in children.

Vesicoureteral Reflux Induces Renal Trauma in A Mouse Model of Ascending, Unobstructed Pyelonephritis

To determine whether in a mouse model of ascending, unobstructed urinary tract infection an inoculum volume could be found that induces vesicoureteral reflux without causing renal injury, the occurrence of vesicoureteral reflux (identified by inspection, kidney culture, and histopathologic examination) was compared with the occurrence of renal trauma (identified by histopathologic examination and cultures of blood and spleen) in female Swiss Webster mice after transurethral inoculation with 50, 75, 100 or 150 μl. of a bacterial suspension containing India ink. Vesicoureteral reflux (which was more common the greater the inoculum volume) induced renal trauma even with small (50 μl.) inoculum volumes, accounting for the observed association of inoculum volume and renal injury. No single parameter of vesicoureteral reflux identified all refluxed or traumatized kidneys. Thus, careful attention to the avoidance of vesicoureteral reflux following inoculation, using multiple indicators of reflux, is needed if this model is to faithfully reproduce infections occurring in the nontraumatized human urinary tract.

Primary vesicoureteral reflux in blacks with posterior urethral valves: does it occur?

Primary vesicoureteral reflux (VUR) is thought to be largely independent of obstruction. Therefore, in patients with urethral obstruction due to posterior urethral valves (PUV) the occurrence of VUR is coincidental. In addition, primary VUR is reported to be uncommon in black children. If these two premises are correct, then primary VUR should be rare in black males with PUV. To test this hypothesis, we reviewed the medical records and radiographs of 43 males with PUV. Twenty-one of the 37 non-black males with PUV had VUR, of which 67% was primary and 33% was secondary. Three of the six blacks with PUV had VUR of which all was secondary. Thus, blacks with PUV lend credence to the theory that primary VUR is not caused by obstruction and support the observation that primary VUR is rare in black children, even those with PUV.

Influence of diuresis on the degree of vesicoureteral reflux. An experimental investigation in rats.

The influence of bladder filling volume (BV), bladder pressure (BP) and diuresis (V) on the occurrence of vesicoureteral reflux (VUR) in Sprague-Dawley rats, where spontaneous VUR is common, has been investigated. The BV and BP at which VUR occurred during constant low diuresis (group I), high inconstant diuresis (group II) and moderately high, constant diuresis (group III), was measured. The abdomen was opened for visual observation of the VUR. The bladder was catheterized with a double-lumen metal catheter for infusion of a Lissamine green saline solution and to enable recording of BP. VUR occurred at significantly lower BV in group II than in group I and at significantly lower BV and BP in group I than in group III.

The Influence of Partial Division of the Intravesical Ureter on the Occurrence of Vesicoureteral Reflux in Dogs

The Influence of Partial Division of the Intravesical Ureter on the Occurrence of Vesicoureteral Reflux in Dogs

The roentgen evaluation of the urinary tract following treatment for vesicoureteral reflux.

urinary tract infection accounted for 6.7 per cent of all hospital admissions to Variety Children's Hospital during the year of 1967. In order to properly evaluate this common cause of disease in the child, a thorough review of the radiographs of children undergoing urinary tract investigation has been correlated with clinical findings and medical and surgical management. Two thousand five hundred and seventy-four roentgen examinations of the urinary tract have been performed on 2,246 pediatric patients during the past five years. Two hundred and sixty-two patients (11 per cent) had vesicoureteral reflux. In 782 patients with proved urinary tract infection, the occurrence of vesicoureteral reflux has been 19 per cent. Material and Method Each of the patients referred to our radiology department for investigation of the urinary tract had both cystourethrography and excretory urography performed by the method previously reported by the authors (1). Both of these procedures are carried out without sedation. ...

The Anatomical Basis and Dynamics of Vesicoureteral Reflux

The Anatomical Basis and Dynamics of Vesicoureteral Reflux