Features treatment of children with congenital ureteral pathology

Abstract

The manifestation variety and the high prevalence of the ureteral pathology, the severity of the resulting complications requires early diagnosis and determination of treatment tactics.
The purpose of the research is to provide the comparative assessments of the treatment results of children with the ureteral pathology and to define the criteria of the treatment efficiency.
Materials and methods. Pathology of the ureter is determined by constant changes in the ureter wall and the impairment of the ureter contractive ability. Screening in diagnostics is the ultrasound of kidneys and the urinary bladder with the diuretic load and Doppler of kidney vessels, intravenous ureography. The gold standard in diagnostics of a refluxing megaureter and vesicoureteric reflux (VUR) is voiding cystourethrogram (VCUG).
Results. One thousand sixty two patients with the different degree of ureteral reflux were treated in the regional children clinical hospital of Dnipro city. They were between the ages of 3 months to 17 years. An examination revealed that 118 children had a severe congenital defect – refluxing megaureter and 624 patients had third-degree VUR. The performed treatment of children with refluxing megaureter along a big size bladder diverticulum (bladder ears) appeared to have been difficult. Extravesical plastic method was used for the treatment. Also endoscopic gel delivery was used during the treatment of children with the refluxing megaureter complicated by the constantly arising pyelonephritis when the inefficiency of minimally invasive methods of treatment appeared. A positive result was achieved in 67.7% of cases. Intravesical plastic was performed for the rest of children. The analysis of treatment was done for 844 children with the different degree of VUR. The positive result was achieved in 211 children with VUR of I-III degree when no evident inflammatory response was manifested. Endoscopic plastic of the uretero-vesicular segment (UVS) was performed on 551 children aged from 6 months to 17 years. A positive result was obtained in 87.3% of cases. In the absence of the effect of the performed treatment, the surgery was performed in 82 patients with the effectiveness of 96.3%
Conclusions. When treating children with congenital refluxing megaureter in the early stages of treatment, preference should be given to conservative and minimally invasive treatment methods. The age of the child and the functional ability of the bladder are important in determining the terms of reconstructive surgery. The criterion for the choice of surgical intervention is defined by the presence of the pathology factors. Extravesical plastic is used more often. The use of nonoperative, minimally invasive and endoscopic treatment methods in the selection of an approach to the treatment of VUR are prioritized and reasonable.
No conflict of interest was declared by the authors.