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Implications of paraureteral diverticulum for the management of vesicoureteral reflux
Author(s) -
Im Young Jae,
Lee Yong Seung,
Kim Sang Woon,
Han Sang Won
Publication year - 2015
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.12828
Subject(s) - vesicoureteral reflux , medicine , diverticulum (mollusc) , urinary system , cystourethrography , reflux , urology , ureter , surgery , disease
Objectives To investigate the clinical importance of paraureteral diverticulum in the management of vesicoureteral reflux by analyzing the relationship between paraureteral diverticulum and recurrent urinary tract infections. Methods We retrospectively reviewed 131 children diagnosed with vesicoureteral reflux. We diagnosed vesicoureteral reflux and paraureteral diverticulum by initial voiding cystourethrography and defined “delayed ureteral drainage” as the presence of contrast media in the upper urinary tract on delayed films after voiding. We analyzed the relationships between paraureteral diverticulum, delayed ureteral drainage and recurrent urinary tract infections. Results The mean age at diagnosis of vesicoureteral reflux was 20.7 months. Of the 202 refluxing ureters, 55 (27.2%) had a paraureteral diverticulum. Of the 55 ureters with paraureteral diverticulum, 51 (92.7%) showed delayed ureteral drainage of refluxing contrast, which was significantly higher than the percentage of delayed ureteral drainage in ureters without paraureteral diverticulum ( P < 0.001). On multivariate analysis of the effect of reflux grade or paraureteral diverticulum on delayed ureteral drainage of refluxing contrast, the odds ratio of paraureteral diverticulum was 11.47 ( P < 0.001). In addition, the risk of recurrent urinary tract infections increased in ureters with paraureteral diverticulum ( P = 0.020). Conclusions In patients with vesicoureteral reflux and paraureteral diverticulum, the risk of recurrent febrile urinary tract infections seems to increase. Therefore, more progressive surveillance and treatment protocols should be considered in these patients.