Treatment and Prevention of Complications after Extra vesical Antireflux Technique

Arap, Sami; Eg, Abrão; G, Menezes de Góes

doi:10.1159/000473237

Cited by 16 publications

(5 citation statements)

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“…Our findings are also comparable with the results of other operative techniques [1,6,7,9,12,13]. The PolitanoLeadbetter reimplantation is technically somewhat more complex and difficult than, for example, the extravesical Lich-Gregoir procedure [2], wherein the submucosal tunnel is created superior to the ureteral orifice.…”

Section: Politano-leadbetter Ureteroneocystostomysupporting

confidence: 85%

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Politano-Leadbetter Ureteroneocystostomy

et al. 2000

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Purpose: We evaluated the results and complications of children with reflux treated with the Politano-Leadbetter ureteroneocystostomy. In particular, we evaluated pre- and postoperative renal parenchymal scarring and the late development of hypertension. Materials and Methods: From 1965 through 1996, 666 children (814 renal units) were reimplanted by nine urologists. The average postoperative evaluation was 10.3 years, and 68.8% of all patiens were evaluable 10 years after surgery. Results: Postoperative complications occurred in 7.8% and consisted of small bowel serosal injury (0.3%), vesicocutaneous fistula (0.4%) and retrovesical hematoma (0.3%). Persistent reflux was the most common postoperative complication (5.6%) and was found to occur in higher grades of vesicorenal reflux. Ureteral stricture and hydronephrosis were seen in 1.2% of children, and was corrected with a secondary reimplantation. Late stricture occurred in all but 1 patient (0.2%). Renal parenchymal scarring was found in 21.2% of patients preoperatively, and this increased over time postoperatively to 27.7%. In 8.7% of these patients, hypertension developed between the 6th and 17th postoperative year. In 6.1%, nephrectomy was carried out, which normalized blood pressures in 87.9% of these 30 patients. Conclusions: The Politano-Leadbetter ureteroneocystostomy was successful in 93.6% of all 814 renal units surgically treated. The operation is safe, but can be associated with late development of hypertension despite correction of the reflux.

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Section: Politano-leadbetter Ureteroneocystostomysupporting

confidence: 85%

“…It responded to transurethral bladder decompression and these children were not adversely affected. This minor complication is rarely discussed in the literature [6,12].…”

Section: Discussionmentioning

confidence: 99%

Politano-Leadbetter Ureteroneocystostomy

et al. 2000

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“…A taxa de cura total é de 98%, observando-se obstrução ureteral em somente 1,5%, devido principalmente aos casos iniciais nos quais o ureter terminal era dissecado extensivamente, causando fibrose periureteral. O RVU persistiu em apenas 0,5% e todos os casos foram reoperados com sucesso empregando-se a mesma técnica, usando um túnel mais longo 67 .…”

Section: Tratamentounclassified

Vesicoureteral reflux in children

Dénes¹,

Arap²

1995

J Pediatr (Rio J)

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A associação entre o refluxo vésico-ureteral e a infecção do trato urinário representa uma ameaça significativa ao rim, na forma de lesão pielonefrítica. São bem claros os eventos fisiopatológicos que propiciam a ascensão das bactérias e sua inoculação no tecido renal, causando danos irreversíveis se não forem adequadamente tratados. A nefropatia de refluxo conseqüente é a causa mais importante de hipertensão e de insuficiência renal na infância. O diagnóstico precoce do refluxo e, principalmente, da agressão pielonefrítica são importantes para um tratamento bem sucedido. A quimioprofilaxia a longo prazo para prevenção de infecção do trato urinário e da cicatriz renal é a forma adequada de tratar o refluxo vésico-ureteral de grau baixo, uma vez que a cura espontânea é esperada na maioria dos casos. Embora a mesma abordagem possa ser empregada no refluxo de grau alto, a cirurgia é uma alternativa favorável, com altos índices de sucesso primário, reduzindo a necessidade de medicação prolongada e de exposição do rim à agressão pielonefrítica recorrente.

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“…Erst mit Einführung der laparoskopischen Technik (4) rückte es plötzlich erneut in den Mittelpunkt des Interesses (8). Die in der Originalarbeit angegebene Technik wurde nachvollzogen und alle Vorteile der auch ambulanten Anwendung bei nicht-eröffneter Blase mit minimalen Komplikationen und reproduzierbaren ausgezeichneten Ergebnissen hervorgehoben (3,5,17,18,25).…”

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“…Immerhin dauerte es 20 Jahre (1,2,3), und möglicherweise wären die Unterspritzungen mit Teflon und Kollagen in einem kritischeren Vergleich zur wiederholt notwendigen Anwendung in Allgemeinanästhesie mit deutlich erhöhter Strahlenbelastung gesehen worden.…”

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Editorial

Hohenfellner¹

1994

Aktuel Urol

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Treatment and Prevention of Complications after Extra vesical Antireflux Technique

Cited by 16 publications

References 1 publication

Politano-Leadbetter Ureteroneocystostomy

Politano-Leadbetter Ureteroneocystostomy

Vesicoureteral reflux in children

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