公益財団法人田附興風会 医学研究所北野病院

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vesicoureteral reflux disease

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vesicoureteral reflux(Bladder replacement therapy)What is

Urine is produced in the kidneys and stored in the bladder through tubes called ureters. Normally, urine is prevented from flowing backward from the bladder to the kidneys, but this is a phenomenon in which urine flows backward from the bladder to the kidneys due to some cause. In most cases, this condition is discovered due to a urinary tract infection (fever). Repeated urinary tract infections put the kidneys at risk of damage.

In infants, the condition may improve naturally as they grow.

The degree of reflux is classified into grades I to V.

Grades of Vesicoureteral Reflux

Treatment of vesicoureteral reflux
...The aim is to prevent kidney dysfunction.

When to consider surgical treatment

  1. Despite taking prophylactic antibiotics, I still get a urinary tract infection.
    Poorly controlled urinary tract infections
  2. Severe reflux (V)
  3. Cases of decreased renal function​
  4. Recurrent urinary tract infections in older children
  5. Severe reflux with lower urinary tract obstruction

New ureterovesical anastomosis
(Submucosal tunnel method: Cohen method)

  • It enters the bladder from the front and pulls out the refluxing ureter into the bladder.
  • The extracted ureter is then threaded under the bladder mucosa to create a new ureteral opening.

merit

High rate of stopping reflux (over 90%)
There is no need for repeated voiding cystography after surgery.

Disadvantages

Hurts in the body. Pain.

Endoscopic (cystoscope) surgery​

This treatment involves injecting hyaluronic acid under the mucosa at the opening of the ureter under cystoscopy to narrow the ureteral opening. It is suitable for grades II to IV vesicoureteral reflux.

merit

Minimally invasive (no scarring, takes about 30 minutes)

Disadvantages

Lower cure rate compared to open surgery Success rate 70%~90%
Even after treatment, reflux needs to be monitored with voiding cystography.
If reflux persists after treatment and infection occurs, further hyaluronic acid injections or open surgery will be required.

Information