Vesico-Ureteral Reflux in the Paraplegic: Cause and Correction

Hutch, John A.

doi:10.1016/s0022-5347(17)68223-5

Cited by 212 publications

(37 citation statements)

References 13 publications

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“…In 1952, Hutch initially described the technique of elongating the intravesical ureter to create an anti-reflux valve in paraplegic patients with VUR [21]. Since then, multiple additional techniques have been described.…”

Section: Open Repairmentioning

confidence: 99%

Surgical management of vesicoureteral reflux in children

Sung

Skoog

2011

Pediatr Nephrol

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Vesicoureteral reflux (VUR) is the most common uropathy affecting children. Compared to children without VUR, those with VUR have a higher rate of pyelonephritis and renal scarring following urinary tract infection (UTI). Options for treatment include observation with or without antibiotic prophylaxis and surgical repair. Surgical intervention may be necessary in patients with persistent reflux, renal scarring, and recurrent or breakthrough febrile UTI. Both open and endoscopic approaches to reflux correction are successful and reduce the occurrence of febrile UTI. Estimated success rates of open and endoscopic reflux correction are 98.1% (95% CI 95.1, 99.1) and 83.0% (95% CI 69.1, 91.4), respectively. Factors that affect the success of endoscopic injection include pre-operative reflux grade and presence of functional or anatomic bladder abnormalities including voiding dysfunction and duplicated collecting systems. Few studies have evaluated the long-term outcomes of endoscopic injection, and with variable results. In patients treated endoscopically, recurrent febrile UTI occurred in 0–21%, new renal damage in 9–12%, and recurrent reflux in 17–47.6% of treated ureters with at least 1 year follow-up. These studies highlight the need for standardized outcome reporting and longer follow-up after endoscopic treatment.

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Section: Open Repairmentioning

confidence: 99%

Surgical management of vesicoureteral reflux in children

Sung

Skoog

2011

Pediatr Nephrol

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“…Since the time of first successful surgical treatment of vesicoureteric reflux by Hutch,[1] various techniques have been described for correction of vesicoureteric reflux. [2345678] Basic goal of all these techniques involves restoration of flap valve mechanism by creating a submucosal tunnel of adequate length according to Paquin's rule,[3] with adequate bladder muscle backing.…”

Section: Discussionmentioning

confidence: 99%

“…[12345678] These principles include adequate mobilization of distal ureter without tension or damage to its delicate blood supply, creation of submucosal tunnel, that is generous in caliber and satisfies the 5:1 ratio of length to width recommended by Paquin,[3] placement of ureter in the submucosal tunnel with muscular backing of detrusor without angulation or twist and, ureteromucosal anastomosis. [9] In certain clinical settings like exstrophy bladder with an abnormal mucosa, neurogenic bladder with detrusor hypertrophy and, in bladders with chronic inflammatory cystitis, creation of submucosal tunnel is almost impossible, while ureters can still be mobilized in correct plane.…”

Section: Introductionmentioning

confidence: 99%

Creation of effective antireflux mechanism without creation of submucosal tunnel in surgical correction of vesicoureteric reflux: Myth or reality?-An experimental study

Gupta

Kureel

2014

J Indian Assoc Pediatr Surg

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Objective:To evaluate the possibility of creating an effective antireflux mechanism without the need to create submucosal tunnel in surgical correction of vesicoureteric reflux.Materials and Methods:Ethical clearance was obtained from the institute ethical committee. The prospective experimental study was conducted on fresh postmortem specimens comprising of intact ureter-bladder-urethra of slaughtered lamb. Through perurethral tube, bladder distension revealed intact antireflux mechanism which disappeared following a cephalad slit of ureteric orifice. After intravesical advancement, mobilized ureters were anchored to the hiatus and the exposed detrusor along the proposed submucosal tunnel after stripping the bladder mucosa. Limited nonobstructed narrowing of the advanced ureteric ends was fashioned. After closure, bladder was distended and reflux was observed through proximal transected ureteric orifices with check cystogram. In second part of experiment, in a rectal reservoir, two intestinal segments as dilated ureters were implanted without creating submucosal tunnel, but anchoring the intrarectal segment to exposed submucosa. Intraluminal end of one segment was narrowed, while other left as such. Reservoir distension test was done to notice the status of reflux. In 24 months, 12 experiments were conducted.Results:In first part of experiment, successful antireflux mechanism was created in 11 ureters. In second part of experiment, reflux persisted in the ureteral segment implanted with obliquity but without distal nonobstructed narrowing, while there was no reflux in the ureteral segment with both obliquity and narrowing.Conclusion:Advancement and anchoring of the ureteral segment to the exposed detrusor with creation of nonobstructive and limited narrowing can create effective antireflux mechanism without the need to create submucosal tunnel.

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“…Since the initial report of surgical correction of VUR by Hutch in 1952 [17], numerous techniques have been developed to accomplish the basic goals of ARS, that is, prevention of retrograde flow of urine into the ureter and kidney. In fact, many of the leading figures in the development of the specialty of pediatric urology made their names largely through their accomplishments in perfecting ARS techniques.…”

Section: Surgical Managementmentioning

confidence: 99%

The Outcome of Surgery versus Medical Management in the Treatment of Vesicoureteral Reflux

Nelson

2008

Advances in Urology

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Evaluation of the relative merits of medical versus surgical management of vesicoureteral reflux (VUR) has been limited by the few prospective studies comparing these strategies. Among those trials that have been reported, the only consistent positive finding has been that incidence of febrile UTI is lower among children undergoing surgical treatment in comparison with medical treatment. Studies have not found significant differences in overall incidence of UTI, or in rates of new renal scarring or progression of existing scarring. It is likely that there is a subset of children with VUR who do benefit from aggressive treatment of their VUR, but we are not yet able to fully determine which children these are. It is hoped that future research will further clarify which treatments are useful in which children.

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Vesico-Ureteral Reflux in the Paraplegic: Cause and Correction

Cited by 212 publications

References 13 publications

Surgical management of vesicoureteral reflux in children

Surgical management of vesicoureteral reflux in children

Creation of effective antireflux mechanism without creation of submucosal tunnel in surgical correction of vesicoureteric reflux: Myth or reality?-An experimental study

The Outcome of Surgery versus Medical Management in the Treatment of Vesicoureteral Reflux

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