Long-term incidence of urinary tract infection after ureteral reimplantation for primary vesicoureteral reflux.
ABSTRACT OBJECTIVE: To determine the incidence of urinary tract infection (UTI) after ureteral reimplantation (UR) for primary vesicoureteral reflux (VUR). MATERIALS AND METHODS: In this retrospective review, the pyelonephritis-free survival of patients with primary VUR who underwent open UR from January 1990 to December 2002 was assessed using a Cox proportional hazards analysis. RESULTS: 1076 patients underwent open UR for primary VUR. 73.0% were female; median age was 4.7 years. 80.1% presented with UTI. Clinical success rate for non-tapered UR was 96.5%. Median follow-up was 2.9 years. 21.8% had at least one postoperative UTI. 6.5% had postoperative pyelonephritis (POP) at a median of 21 months postoperatively. On multivariate survival analysis female gender (OR 9.97, 95% CI 3.07-32.34), preoperative VUR grade ≥3 (2.14, 1.25-3.69), breakthrough preoperative UTI (2.00, 1.22-3.25), and preoperative renal scarring (1.86, 1.15-2.99) were associated with POP. CONCLUSION: POP is rare on long-term follow-up, suggesting that UR is effective in reducing pyelonephritis in this population.
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ABSTRACT: The aim of this paper is to report a case of severe hydronephrosis and incontinence 20 years after bladder exstrophy repair, managed successfully by secondary ureteroneocystostomy and by transurethral submucosal injection of Macroplastique.Case reports in urology. 01/2012; 2012:324510.
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ABSTRACT: Abstract Objective. The aim of this study was to evaluate the clinical outcome after endoscopic therapy by injection of bulking agent in the treatment of occult vesicoureteral reflux (VUR) [no VUR on standard voiding cystourethrography (VCUG), but positive (99m)Tc-2,3-dimercaptosuccinic acid (DMSA) scan] in females who have recurrent febrile urinary tract infections (UTIs). Material and methods. A case series was retrospectively identified of 24 females (mean age 15.5 years) with negative VCUG, but renal scars in one (n = 4) or both (n = 20) kidneys on DMSA scan. Endoscopic injection was performed bilaterally in 20 (83.3%) and unilaterally in four patients (16.7%). The incidence of postoperative UTIs was documented with a mean follow-up of 2.5 years (range 1-6 years). Results. The mean renal part function (DMSA scan) on the left and right sides was 53.5% (15-74%) and 47.3% (26-85%), respectively. Twenty-one out of 24 patients (87.5%) showed no evidence of any febrile UTIs postoperatively. One patient (4.2%) experienced a further febrile UTI 6 months after treatment. Two other patients (8.3%) had one questionable afebrile UTI, 4 and 3 years after therapy. Pressure-flow electromyography confirmed a dysfunctional voiding pattern in 12 patients (50%) treated with pelvic floor therapy and behavioural interventions before endoscopic therapy. Conclusions. Injection of bulking agent seems to be a suitable treatment for occult VUR in females to prevent further febrile UTIs. Patients with occult VUR should undergo a careful evaluation of possible urodynamic disorders such as dysfunctional voiding. These findings should be studied in prospective trials before drawing any conclusions.Scandinavian journal of urology. 03/2014;