Combination of vesicoureteric reflux and vesicoureteric junction obstruction.

OBJECTIVE: This study analysed the association of vesicoureteric reflux (VUR) and vesicoureteric junction obstruction (VUJO) requiring surgical interventions in infants and children. MATERIAL AND METHODS: Over 30 years (1975-2004) 423 infants and children were operated on because of VUR, 163 owing to VUJO and 25 patients (33 ureters) with a combination of VUR and obstruction of the vesicoureteric junction on the same side. For both pathological entities ureteral reimplantation was performed along with excision of the narrowed and refluxing distal ureteric segment. The age of patients at surgery ranged from 3 months to 11 years (average 2.6 years). The female to male ratio was 1.4:1. RESULTS: Out of the 25 patients (33 ureters), both entities were diagnosed before surgery in 10 of them (15 ureters). In 15 cases (18 ureters), only the VUR was preoperatively diagnosed; however, the VUJO was only suspected and confirmed during the operation. In one refluxing ureter, the obstruction was not diagnosed during subureteric endoscopic injection of the orifice. In five of the 33 ureters, redo reimplantation was necessary because of obstruction (four ureters) or reflux (one ureter). CONCLUSIONS: A combination of VUR and VUJO should be taken into consideration in a patient with proven reflux, where the ureter is dilated and tortuous and following urination the hydronephrosis and hydroureter persist or slowly decrease. In such cases long-term prophylaxis and endoscopic treatment are contraindicated but open surgery (reimplantation) is recommended.

Role of the Teflon deposit in the recurrence of vesicoureteral reflux.

A relationship between the Teflon deposit, visible with ultrasound, and long-term success of subureteric Teflon injection (STING) treatment was investigated. The study included only those patients with primary vesicoureteral reflux (VUR), in whom the reflux had disappeared and the Teflon deposits were visible 6 weeks following STING treatment. Cessation of VUR was proven by voiding cysto-urethrography (VCUG) in 99 patients (143 ureters). Average follow-up time was 9 (4-12) years. Patients were divided into two groups: group I, deposits visible with ultrasound [deposit (+)], and group II, no visible deposits at the end of the follow-up period [deposit (-)]. Reflux recurrence, the occurrence of urinary tract infection (UTI), and pyelonephritis were investigated, and technetium scintigraphy scans were examined. The deposit (+) group included 43 patients (65 ureters), and the deposit (-) group contained 56 patients (78 ureters). In the deposit (+) group there were no recurrences of VUR; however, 17 recurrences were found in the deposit (-) group (P < 0.05). Dimercaptosuccinic acid (DMSA) scintigraphy scans and occurrence of UTI showed significant difference between the groups (P < 0.05). A close relationship was found between the disappearance of the Teflon deposit and the recurrence of VUR. Disappearance of the Teflon deposit and repeated bacteriuria is a warning sign of the recurrence of VUR; therefore, VCUG might be warranted for these patients.