Vesicoureteral reflux (unphysiological backflow of urine from the bladder via the ureters into the renal pelvis) and megaureter (congenital ureteral malformation in which the ureter is massively dilated and increasingly tortuous (as a sign of an increase in length))

In order to achieve complete urinary incontinence, the bladder must be able to collect the urine that flows into the bladder via the ureters and then empty it completely via the urethra in a controlled manner. The point where the ureter joins the bladder plays an important role in this process. Here, nature has developed a kind of valve mechanism that only allows urine to flow in one direction: due to the inclined course of the ureter in the bladder wall, the ureter is "squeezed" as the bladder fills up and is therefore closed. If this valve mechanism is disturbed, two consequences are possible:
- the outflow of urine into the bladder is obstructed, resulting in a build-up of urine BEFORE the bladder, in which case we see a widening of the ureter on ultrasound (so-called "obstructive megaureter")

- the "valve" does not close properly and the urine flows BACK from the bladder into the kidney.

In both cases, urine remains in the urinary tract system for too long, thus promoting the occurrence of urinary tract infections.

Basic urological diagnostics by means of instrumental examinations (so-called "imaging diagnostics") is based on three main pillars:

1. it always begins with an ultrasound of the kidneys and urinary tract to look for structural abnormalities.

2. this diagnosis is supplemented by an X-ray examination of the bladder (so-called micturating cystourethrography or "MCU").

In an MCU, a catheter is inserted into the bladder through the urethra and the bladder is filled with an X-ray contrast medium. The contrast medium is then examined during urination to see whether it flows back to the kidney via one of the two ureters. In boys, the urethra can also be visualized laterally.

3 Finally, a nuclear medicine examination procedure(isotope nephrography or "ING") is used to assess kidney function from a static and dynamic point of view. The blood supply, function and excretion or outflow of each individual kidney are assessed.

In children who can already control their own urine output, the urine flow (so-called "uroflowmetry with residual urine determination") is also measured. Whether your child then needs an operation always depends on the specific examination results and must be assessed individually in each case and discussed with you. There are no generally applicable rules here.

In principle, however, it can be said that in the case of obstructive megaureter (if the ureteral dilatation is caused by a narrowing of the ureter at its orifice into the bladder), spontaneous correction is very likely. Surgical intervention is only required in exceptional cases, and we will examine the necessity of this very carefully together with you.

 

 

There are several options for the treatment of vesicoureteral reflux, the common goal of which is to avoid complicated (with fever) and uncomplicated urinary tract infections.

The conservative approach does not involve surgery. Antibiotic prophylaxis is given for varying lengths of time. The urine must be checked regularly in any case, as even careful prophylaxis does not completely protect against infection. Alternatively, it is also possible to proceed without prophylaxis, although urine checks must then be carried out more closely in order to detect and treat an incipient infection in good time.

- As a less invasive step, vesicoureteral reflux can now be treated by injecting the opening of the ureter into the bladder (ostium). This procedure is always performed under general anesthesia. A special camera (cystoscope) is inserted into the bladder via the urethra and a hardening gel is then injected under the ostium. The success of this procedure, which can also be repeated, depends on the extent of the reflux, among other things.

- Several techniques are available for surgical anti-reflux surgery (ureteral reimplantation into the bladder), which can be performed open or minimally invasive (e.g. according to Politano-Leadbetter, Lich-Gregoir, Cohen). The choice of procedure depends on the specific situation and is also at the discretion of the surgeon. Ultimately, the decision is reserved for a detailed consultation.

Our diagnostic and therapeutic procedure corresponds to the concept described above. Of course, we try to avoid duplicate examinations and therefore first review findings that have already been made elsewhere. The further diagnostic and treatment plan is individually adapted and cannot be outlined in detail. However, it is still the case that we strive to obtain the best possible information for your child with a minimum of stress.

Patients who undergo ostium injections are only kept under inpatient observation until the following day after the procedure. The inpatient stay after a surgical anti-refluxplasty depends on the type and duration of the procedure. However, the principle of fast-track surgery also applies here. Patients who have recovered well from the operation and whose parents have learned how to deal with splints and drains that are still in place can be discharged home in the meantime if they wish.

The follow-up care of these patients is carried out in close cooperation with the treating pediatrician and is based on the respective test results. As a rule, we limit ourselves to urine tests and ultrasound of the kidneys and urinary tract as part of the follow-up examinations; invasive examinations(MCU, ING, etc.) are not generally planned