The results of operative treatment of high grade vesicoureteral reflux in children

Markov N.V., Kagancov I.M., Turabov I.A., Sablin D.E., Dubrov V.I., Logval' A.A.

The relevance of determining the optimal method for the elimination of vesicoureteral reflux (VUR) in children is due to the prevalence of VUR in children with urinary tract infection and the risk of damaging the renal parenchyma in the presence of reflux, especially with high-grade (IV-V). In recent decades, endoscopic intervention with the use of various uroimplants became the method of surgical treatment of VUR. Among the open surgical interventions the most common is the neoimplantation ureter by Cohen’s procedure.

The work is based on experience of surgical treatment of 69 children (95 ureters) with grade IV-V primary vesicoureteral reflux (VUR) in Arkhangelsk Regional Children Clinical Hospitalin 2004-2016 both by endoscopic surgery and by open surgical correction according to Cohen’s procedure. Average age of patients was 49.6 months. First group of patients consisted of 35 children (46 ureters) who underwent Cohen’s procedure. Second group of patients consisted of 34 patients (49 ureters) who underwent endoscopic injection with such bulking agents as URODEX and VANTRIS. Success rate of Cohen’s ureter neoimplantation was 91,3%. On the opposite, success rate of endoscopic correction did not exceed 38,8 % (with taking repeated endoscopic correction into consideration).

The rate of complications after Cohen’s procedure was significantly lower then after endoscopic treatment in children with high-grade VUR (p<0,01).

Therefore we may conclude that the Cohen’s procedure is still the most effective mode of treatment of Grade IV-V VUR. Endoscopic correction is ineffective regardless of bulking agentsused.

Authors declare lack of the possible conflicts of interests. 

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vesicoureteral reflux, neoimplantation according to Cohen’s procedure; endoscopic correction; efficiency of treatment