An Analysis of Post Surgical Outcome in Primary Vesico Ureteric Reflux Patients

Poornima, A E (2012) An Analysis of Post Surgical Outcome in Primary Vesico Ureteric Reflux Patients. Masters thesis, Madras Medical College, Chennai.


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7 INTRODUCTION: Vesico ureteral reflux is a dynamic event – the retrograde flow of bladder urine into the upper urinary tracts. It’s a feature of disordered anatomy and function at the uretero vesical junction. Although this reflux nephropathy may disappear during growth, it is of clinical concern because of the morbidity from ascending urinary infection and associated nephropathy that can lead to hypertension and renal function insufficiency. To reduce the morbidity and mortality associated with vesico ureteric reflux, there are many studies available all over the world with relation to the pre-op work up, medical and surgical management, post operative follow up and outcome. AIMS AND OBJECTIVES: 1. To analyse the post surgical outcome in primary vesicoureteral reflux patients with the clinical and imaging parameters in the follow up. 2. To analyse the primary vesico ureteral reflux treated surgically with those treated by chemoprophylaxis alone. MATERIALS AND METHODS: This a prospective study conducted in the department of pediatric surgery, Institute of Child health over a period of 2½ years. This study was performed between August 2009 and January 2012 for primary vesico ureteral reflux. Apart from the clinical examination, baseline investigation, blood parameters, ultrasonogram – voiding cystourethrogram intravenous urogram and DMSA scan were taken. Patients were followed up for and more year post operatively for resolution of reflux and urinary tract infection. Patients treated surgically were compared with those treated with chemoprophylaxis alone in terms of recurrent urinary tract infections and resolution of reflux as demonstrated by voiding cystourethrogram. SELECTION CRITERIA: Inclusion Criteria: All patients with primary vesico ureter reflux (i.e due to intrinsic defect within the ureterovesical junction) irrespective of grade or laterality. Exclusion Criteria: All patients with secondary vesico ureteral reflux as a result of another pathology like associated bladder outlet obstruction (posterior urethral valve) and neurogenic bladder dysfunction are excluded from the study. CONCLUSION: 1. Majority of cases presented at an age of <3 years and all were symptomatic with history of recurrent UTIs. 2. Male female ratio was 1:0.6, predominately males in our study. 3. Bilateral cases were 62.9% as compared to 37.1% unilateral cases. 4. Grade III, IV, V reflux constituted 83.9% of total renal units. 5. Type of surgery was predominantly Cohen’s Reimplant with success rate of 95.6%. 6. In ultrasonogram, an increase in diameter of the ureter and/or renal pelvis was observed as a sign of reflux. 7. Micturiting cystourethrogram is an investigation tool for grading the reflux pre operatively and for the detection of post operative resolution. 8. Surgery is the preferred option for persistent Gr.III & IV and all Gr.V reflux. 9. Many patients who eventually required surgical management had already suffered kidney damage. So, early referral for surgical intervention would reduce the number and extent of renal damage due to reflux.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Post Surgical Outcome, Primary Vesico Ureteric Reflux Patients.
Subjects: MEDICAL > Paediatric Surgery
Depositing User: Subramani R
Date Deposited: 16 Feb 2020 01:51
Last Modified: 16 Feb 2020 01:51

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