Clinical study about vesicoureteral reflux at Aleppo University Hospitals

ABSTRACT

This subject aimed to study the ureterovesical reflux. It is divided into two major parts The first one was a review of literature which contains at first the history of this disease when it was recognized as a clinical entity, then the embryology, anatomy and physiology of the ureterovesical junction. After that the incidence, epidemiology, etiology, pathogenesis and complications were studied. This part contains the clinical features, symptoms and signs. Then the diagnosis of VUR was studied which contains laboratory findings, radiologic findings, classification grades and instrumental examination. It has mentioned the differential diagnosis and treatment which Contains two types The first one was medical treatment which contains 1-Treatment of destruction of the ring of distal urethral in little girls or posterior urethral valves in boys 2-Elimination of the infection by anti microbial drugs which should be continued for 6 months or more. 3-Triple voiding. 4-Placement of urethral catheter in infant girls with markedly dilated upper urinary tract. The second type of treatment is the surgical treatment which contains a-Indications of it. b-Types of surgical treatment 1-Temporary urinary diversion. 2-Permanent urinary diversion. 3-Other surgical treatments such as a-Heminephrectomy b-Nephrectomy c-Transuretero ureterostomy 4-Definitive repair By many types of operations such as 1-Hutch 1963 2-Gleen-Anderson 1967 3-Politano Lead beater 1958 4-Panquine 1959 5-Cohen 1975 6-Lich's 1976 7-Flocks 1961-8-Endoscopic correction of vesicoureteral reflux The second part of this study was practical section, it contains 50 patients admitted to the urologic department of Aleppo University Hospital at the period between 1/1/1995-20/9/2004. Among these cases, 20 had a medical treatment and the other 30 had a surgical treatment. The disease was bilateral in 30 cases, on the right side in 12, and on the left side in the rest 8 cases as the following [Table I] Table [I] Show No. of cases and the affected sides. The affected side-Number of cases-[%] Right side-12-24%; Left side-8-16%; Bilateral-30-60%; Total-50-100%. The number of cases was much more in females than in males as the following table. Table [II] Cases as affected by sex. The sex-Number of cases-[%] Female-33-66%; Male-17-34%; Total-50-100%. Most cases were between 5-10 years old [table III] as the following Table [III] Case as affected by age. Age-Number of cases-[%] 1-4-21-42%;; 5-9-15-30%;; 10-15-8-16%; 16-20-4-8%; > 20-2-4%; Total-50-100%. The results of urine analysis made for these patients were as the following table. Table [IV] The results of urine analysis. Urine analysis-Number of cases-[%] Sterile Reflux-12-24%; Non sterile reflux-38-76%; Total-50-100%. Vesicoureteral reflux was classified into 5 grades by voiding cystourethrogram as shown in the following table. Table [V] classification of Vesicoureteral reflux. Grade-Number of cases-[%] I-33-66%; II-9-18%; III-2-4%; IV-3-6%; V-3-6%; Total-50-100%. The treatment of reflux was medical made in 20 patients 35 ureters and surgical in 30 patients 85 ureters as illustrated in table [VI]. Table [VI] Type of treatment according to number of patients. Type of treatment-Number of patients-Number of ureters-[%]; Conservative treatment-20-35-40%; Surgical treatment-30-50-60%; Total-50-85-100%; The surgical treatment of reflux was achieved by three methods: 21 patients were treated by Politano Lead beater method. 6 patients were treated by Cohen method. 3 patients were treated by Lich's method. Table [VII] Type of surgical technique according to number of patient. Type of surgical technique-Number of patients-[%] Politano Lead beater-21-70%; Cohen technique-6-20%; Lich's technique-3-10%; Total-30-100%. The final results of the surgical treatment achieved by the three methods were as the following [table VIII]. Table [VIII] The final results and its percentages. Final results-Number of cases [ureters]-[%] Absence of reflux[cure]-29-87.8%; Stenosis of vesicoureteral junction-1-3%; Persistance of reflux-3-9.2%; Total-33-100%. These results were compared to the results of Dr. Randell Scotte [1977] as in the following table Table [IX] Shown comparative studies. Final studies-Our studies-Study of Randell Scotte Cure-87.8%-97%; Stenosis of UVJ-3%-3%; Persistance of reflux-92%-3%. Finally Vesicoureteral reflux is very important, so studying and management of this disease are necessary to avoid the renal injury which lead in turn to the renal failure. In addition, the early diagnosis and treatment vesicoureteral reflux will make the results of treatment better and avoid the complications