Long term outcomes of Cohen’s cross trigonal reimplantation for primary vesicoureteral reflux in poorly functioning kidney

ARTICLE HIGHLIGHTS

Research background

Vesicoureteral reflux (VUR) is when urine flows backwards from the bladder to the upper urinary tracts. It often has no symptoms but can cause kidney damage and scarring, leading to renal insufficiency, hypertension, or end-stage renal disease. Surgical options like ureteric reimplantation may be considered for poorly functioning kidneys, but there is limited evidence on long-term outcomes.

Research motivation

The motivation behind the research was to address the lack of evidence in the literature regarding the long-term outcomes of open ureteric reimplantation for poorly functioning kidneys with VUR. This research was conducted to provide better insights and guidance on the optimal management of VUR with poorly functioning kidneys.

Research objectives

The aim of the study was to determine if poorly functioning kidneys with VUR maintain relative renal function after the surgery on long-term follow-up of 5 years or more.

Research methods

The study involved a retrospective review of medical data for 168 patients who underwent ureteric reimplantation between 2003-2019. The research focused on children with unilateral primary VUR and a relative renal function of less than 35% who underwent open or laparoscopic ureteric reimplantation between January 2005 and December 2017. Data was collected by two independent researchers, and patients were excluded based on specific criteria. Preoperative evaluation included a voiding cystourethrogram and Dimercaptosuccinic acid (DMSA) scan, EC scan, and S. Creatinine. Follow-up was done at 6-month intervals, and data was collected through various tests to assess the patient's cortical function. A paired-samples t-test was used to compare pre- and post-surgery observations. Only patients with complete data records and regular follow-up were included in the study.

Research results

The study included 31 children who underwent ureteric reimplantation for unilateral primary VUR. The patients were predominantly male, and their mean age was 5.21 ± 3.71 years. The pre- and postoperative renal function, as measured by DMSA scan, remained statistically equal in most patients, and there was no significant change in serum creatinine. Only one patient had persistent reflux after surgery, and one had a recurrent UTI. None of the patients showed an increase in scarring, proteinuria, or hydronephrosis after surgery, and there were no new cases of hypertension.

Research conclusions

The study found that even poorly functioning kidneys maintain their function in the long term after undergoing ureteric reimplantation, suggesting that this procedure may be a better option than nephrectomy. The results also indicate the need to establish a protocol for long-term follow-up of patients who have undergone this procedure, as hypertension and proteinuria do not progress over time in these patients.

Research perspectives

The study findings suggest the need for further research on the long-term outcomes of ureteric reimplantation in poorly functioning kidneys in children with VUR. Future studies could investigate the factors that influence the success of ureteric reimplantation, such as age of the patient, severity of VUR, and degree of renal scarring. Additionally, studies could explore alternative treatments for VUR and their long-term outcomes, such as endoscopic injection of bulking agents or laparoscopic ureteric reimplantation.