Vesicoureteral reflux is when the urine goes back from the bladder into the kidneys due to defective “valves” at the junction of the ureter with the bladder.
Some children with vesicoureteral reflux suffer from recurrent febrile urinary tract infections, where the child has temperatures of more than 101.5 and urinary symptoms (if the child is old enough to be able to report them). Some of these infections can scar the kidney (15% of the times).
A child with vesicoureteral reflux and history of febrile UTI’s will have a roughly 40-50% chance of another febrile UTI if no treatment is given. If the child receives a daily dose of a preventative antibiotic, the chance of recurrent febrile UTI’s decreases by about 12% to somewhere around 28-38%. Surgery will decrease the chance of recurrence even more down to 10-20%.
Surgery for vesicoureteral reflux can be done different ways:
- Endoscopic treatment: a paste is injected using a telescope inside the bladder. No incisions are made. Patient goes home the same day after a 30 minute procedure. You can find information about this procedure here: http://www.deflux.com/. Endoscopic treatment will cure reflux in 70-80% of children, although some centers have reported higher success rates (Atlanta). Complications after endoscopic treatment are rare.
- Ureteral reimplantation: this surgery redirects the ureter inside the bladder in a way as to create a “new valve”. Success rates for this surgery are above 90%. Ureteral reimplantations can be done many different ways (from inside the bladder, outside the bladder). Although the surgery is more successful, complications can occur in around 5% of patients.
I usually do my reimplantations laparoscopically using the Da Vinci Robot following the principles of HIDES (Hidden Incision Endoscopic Surgery). What this means is that incisions are made where no one would usually see them (under the bikini line and inside the belly button).
Here is a picture of a girl that had a ureteral reimplantation with the Hidden scars technique.
The surgery takes anywhere from 2-4 hrs. Patients are discharged from the hospital in the first 24 hrs after the procedure most of the times.