Abstract
Objective: Vesicoureteral reflux (VUR) constitutes 10- 20% of all antenatal hydronephrosis cases. In this study, 21 cases who have been monitored by reason of primary VUR diagnosis upon antenatal hydronephrosis were evaluated. Treatment and monitoring results are discussed in the light of literature.
Material and Methods: 21 (36 renal-ureter units) cases being followed-up with a primary VUR diagnosis after antenatal hydronephrosis symptom between May 2006 and June 2013 in our clinic were evaluated retrospectively. Genders, ages of application, VUR and hydronephrosis grades of the cases were evaluated. Circumcision situation of the male cases and prophylactic antibiotic usage periods were obtained from the hospital file resources and by contacting their parents. The cases were divided into 3 groups as those who had undergone ureteroneocystostomy (UNC) as the first intervention, those who had undergone subureteral material injection (STING) as the first intervention followed by UNC, and those who have just undergone STING and were being followed-up.
Results: 21 cases, 3 female (14.3%) and 18 male (85.7%), who were found to have primary VUR after an intrauterine hydronephrosis diagnosis were included in the evaluation. The cases had reflux in 36 renal-ureter units in total including 15 cases (71.4%) that were bilateral, 4 cases (19.1%) in the left and 2 cases (9.5%) in the right ureter. In the whole series, second-degree reflux existed in 1 ureter (2.7%), third-degree reflux in 6 (16.6%) ureters, fourth-degree reflux in 6 (16.6%) ureters and fifth-degree reflux in 23 (63.8%) ureters. STING was applied as the first intervention in 32 ureter units. On the other hand, UNC was applied as the first intervention in 2 (4 ureter units) cases. It was seen that UTI was ongoing after STING intervention in 8 of 19 cases. Simultaneous circumcision operation was performed in any STING session in 14 of the 18 males. It was seen that UTI disappeared in 10 of those circumcised and recurrent UTI was ongoing in 4 of them. It was seen that reflux disappeared only upon STING application in 14 (38.8%) of 36 ureters. It was also seen that 18 (50%) ureters recovered from reflux after the application of UNC. Surgical treatment success rate was 88.8% in the primary VUR cases diagnosed upon antenatal hydronephrosis.
Conclusion: High-grade VUR patients diagnosed upon antenatal hydronephrosis and having affected renal functions should be considered as candidates for chronic renal failure by reason of the dysplasia that has developed in the intrauterine period and should be followed-up closely
Keywords: Antenatal hydronephrosis, Circumcision, Vesicoureteral reflux
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