A CLINICAL STUDY OF CHILDREN'S VUR ASSOCIATED WITH SO-CALLED PARAURETERAL DIVERTICULA

Abstract

A clinical study was made of children's VUR associated with vesical hilar diverticulum.
Eighteen patients of VUR accompanied by hernias around the ureteric tunnel in the bladder were found during these 10 years. Six of them were required of anti-VUR operation and the remaining were conservatively observed with or without anti-bacterial agents for various periods. They were classified into 2 groups: 11 of them (group A) had paraureteral diverticula and 7 (group B) had periureteral diverticula. Four patients (group C) who had a cystic dilatation of the terminal end of a refluxing ureter with VUR were studied in this series, too.
VUR of group A occurred with a high intravesical pressure and morphological findings of the ureteral orifices being normal except two cases. One case with right complete duplication showed some swelling around the ureteral orifice, which was found to belong to refluxing lower urinary collecting system at the operation and the other had a left large vesical diverticulum including the left ureteral orifice with severe VUR in its bottom.
These cases had VUR of low intravesical pressure type. VUR of group B presented a low intravesical pressure, associating morphological abnomality of the ureteral orifice in the majority of them.
Para and periureteral diverticula were found with a high intravesical pressure or after voiding by VCUG and in some cases cystoscopically. Saccular formation was observed cystoscopically and/or operatively in three patients in group A.
Operative procedures for 11 ureters of the all 7 patients obtained good results by a modified Politano-Leadbetter method in 10 and by Cohen method in one.
15 ureters of 12 individuals except 3 of short following up periods were conservatively observed for 16 to 82 months (average 42.7 months). VUR disappeared in 4 ureters of them, showed grade down in 4 and remained unchanged in the remainder.
The refluxing ureter with either para or periureteral diverticulum lacks in the anti-refluxing mechanism, such as weakness of hilar muscle structure and undergrowth of intramural ureteral muscle bundles in the literatures.
Urinary stasis in the terminal end of the ureter was recognized in many cases (19/31, ureters) but considered to have little influence on the upper urinary tract.
Renal function were kept normal to moderate in all cases. Therefore, operative procedure is not always required for VUR associated with vesical hilar diverticula, if they are followed carefully case by case.