OBSTRUCTIVE COMPLICATIONS OF ENDOSCOPIC TREATMENT OF VESICOURETERAL REFLUX IN CHILDREN


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Abstract

The study was aimed to the selection of patients, in which endoscopic treatment of vesicoureteral reflux (VUR) is contraindicated due to the high risk of the formation of obstructive hydroureteronephrosis (HUN). From June 1991 to December 2011, endoscopic treatment of I-V degree VUR was performed in more than 4,000 children aged 4 months to 17 years. In period of wide use of endoscopic technique, obstructive HUN occurred in average in 1 (0,5%) case of 200 VUR (5 cases in 5 children), only in IV degree reflux and in only in children with initial subcompensated obstruction of ureterovesical segment, which was manifested as flask-shaped extension of juxtavesical ureter on intravenous urograms. Ureterocystoneostomy allowed to resect the terminal ureter with encapsulated implants in 4 out of 5 children. The macroscopic and histological examination of biopsy specimens confirmed the correct position of the implant in all cases, which excluded the technical complications. Thus, persistent decompensation of urodynamics of upper urinary tract is the result of increased pressure profile of the terminal ureter, inevitable in the endoscopic treatment of UVR, in children with initial obstruction of ureterovesical segment. Therefore, endoscopic treatment is contraindicated for children with high-degree reflux and radiological signs of obstruction of the terminal ureter.

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