Tratamento cirúrgico do refluxo vesico-ureteral na população pediátrica.

Abstract

Early diagnosis and adequate follow-up are fundamental principals for the treatment of vesicourethral reflux in children. The treatment options in these cases remain an individual choice based on multiple factors.To determine and compare the effectiveness of two different surgical techniques (endoscopic and conventional) used on vesicourethral reflux treatment.Cohort study, based on the clinical files of children and adolescents submitted to surgical treatment of vesicourethral reflux, between the 1st January of 2000 and 30th April 2006. The study included one year period of follow-up. Multiple variables with a presumable influence on the therapeutic option were analysed. In cases of surgical treatment, effectiveness and safety of the surgical technique where determined.Included 46 children and adolescents, in a total of 68 refluxive units. Thirty seven of all renal units, where submitted to endoscopic treatment: the success rate with one injection of Deflux® was 62% (IC 95% [0.46; 0.78]), increasing for 78% (IC 95% [0.65; 0.91]) when the second injection was performed. Thirty seven renal units were submitted to open surgery: Cohen procedure in 21 patients and nefrourethrectomy in two cases. Excluding the nefrourethrectomy, the classical surgery had a success rate of 97% (IC 95% [0.91; 1]). The reason between probabilities of success, considering endoscopic surgery vs. conventional surgery was 0,8 (IC 95% [0.68; 0.97]). Registered thirteen complications, most of them (85%) after conventional surgery. Discussion: The high complication rates determined for conventional surgery could justify the frequent option for endoscopic surgery in small centres, despite its lower success rates.This study confirms that this therapeutic option establishes a good commitment between prophylaxis safety and classical surgery effectiveness.