Results of operative treatment of vesicoureteral reflux by the Leadbetter-Politano method in children

[Primary vesicoureteral reflux treatment in childhood: comparsion of two systematic review]

Many medical practices are being carried out unawares of their efficiency, or of their actual impact on the health of the patients, therefore it is necessary to consider the support of professional recommendations with scientific evidence.

THE PRIMARY OBJECTIVE

To perform a systematic review (SR) of the therapeutic management of primary VUR in pediatric urology.

MATERIAL AND METHODS

A systematic review has been performed, including scientific evidence-based medicine criteria, of the articles published in all of the available databases. Inclusion criteria concerning basic quality of the articles were considered essential, as well as exclusion criteria to be able to reject the articles.

RESULTS AND DISCUSSION

Subsequently, and following the critic reading of greater than 320 articles, statistical study of the grouped data was performed according to the type of treatment and to the benefits contributed by each treatment, and also to their undesirable effects. Finally we have made a comparison between our results and recent Cochrane Systematic Review. The following Conclusions were drawn from the results obtained and from the analysis of the texts. Both medical and surgical treatment present with similar effectiveness concerning resolution of grades I, II and III of VUR, and the former one is the recommended initial treatment following diagnosis. Endoscopic treatment is exactly as effective as open surgery for grades I, II and III with fewer undesirable effects secondary. There are no differences concerning the efficacy of the different injected substances. Not enough evidences exist for degrees IV and V that may recommend or advise against any of the treatments. In any degree of VUR, open surgical treatment is superior as far as medical treatment is concerned only regarding the number of acute pyelonephritis episodes during followup. This conclusion cannot be applied on endoscopic treatment.

Ureterocystoplasty for megaureter: a technique practicable in bladder wall fibrosis

The cause of megaureter (hydroureter) is inadequacy of the ureterovesical junction. The only possible means of its therapy consists in a surgical reconstruction of the ureterovesical junction. A technical modification of ureterocystoplasty for megaureter, having been employed since 1976, is described. It basically consists in the construction of a tunnel from the ureter within the bladder, the ureter being sutured to the wall of the bladder only loosely. In 150 children 182 ureteroneocystoplastic operations were done. As confirmed by the postoperative course, as well as by the results of the follow-up studies, the technique may be used with benefit even in case of infection, impaired renal function or bladder wall fibrosis.