Journal of Pediatric Urology (2015) 11, 44
Commentary to “Refluxing ureteral reimplantation: A logical method for managing neonatal UVJ obstruction” Tom P.V.M. de Jong, Aart J. Klijn, Pieter Dik, Rafal Chrzan, Caroline F. Kuijper, Keetje de Mooij University Children’s Hospitals UMC Utrecht and AMC Amsterdam Utrecht, The Netherlands Correspondence to: T.P.V.M. de Jong, Head of Pediatric Urology, University Children’s Hospitals UMC Utrecht and AMC Amsterdam, Lundlaan 8, P.O. Box 85090, Utrecht, 3508AB, The Netherlands [email protected] (T.P.V.M. de Jong) Received 3 September 2014 Accepted 4 September 2014 Available online 4 February 2015
Kaefer et al. [1] advocate, in case an indication exists for surgical intervention, to turn an obstructive megaureter into a refluxing one as a temporary solution to avoid reimplant surgery in infants. They do this based on a concern that reimplant surgery should be avoided under the age of 12 months. No scientific proof exists to support this concern that for some people in pediatric urology is a dogma that they strictly adhere to. In contrast, ample scientific proof exists that infant recalibration and reimplantation can be done safely with good results and without any risk for the urodynamic properties of the bladder [2e5]. In this current series, the children are brought into a compromised situation twice because of the need for extra definitive reconstructive surgery at a later age. Therefore, in our opinion, the message should be: if one is not confident to do a major reconstruction in a neonate, refer the patient to a center where, regardless of age, the patient can be treated adequately in one step, instead of bringing the patient at risk by creating a refluxing megaureter. An obstructive megaureter is not an indication for any temporary measures except for a nefrostomy tube in case of a pus-filled system in a septic child or a cutaneous ureterostomy when severe doubts exist on the viability of the kidney, to observe whether
enough recovery in function of the obstructed kidney occurs. Furthermore, the combination of a megaureter with a hostile bladder in case of severe posterior urethral valves may be an indication for cutaneous ureterostomies, to overcome the time that the bladder needs to settle down.
References [1] Kaefer M, Misseri R, Frank E, Rhee A, Don Lee S. Refluxing ureteral reimplantation: a logical method for managing neonatal UVJ Obstruction. J Pediatr Urol 2014 oct;10(5):824e30. [2] de Kort LM, Klijn AJ, Uiterwaal CS, de Jong TP. Ureteral reimplantation in infants and children: effect on bladder function. J Urol 2002;167: 285e7. [3] Beganovic A, Klijn AJ, Dik P, De Jong TP. Ectopic ureterocele: long-term results of open surgical therapy in 54 patients. J Urol 2007;178: 251e4. [4] Hanna MK. Early surgical correction of massive refluxing megaureter in babies by total ureteral reconstruction and reimplantation. Urology 1981;18:562e6. [5] Matsumoto F, Tohda A, Shimada K. Effect of ureteral reimplantation on prevention of urinary tract infection and renal growth in infants with primary vesicoureteral reflux. Int J Urol 2004;11:1065e9.
DOI of original article: http://dx.doi.org/10.1016/j.jpurol.2014.01.027. http://dx.doi.org/10.1016/j.jpurol.2014.09.003 1477-5131/ª 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
Commentary to “Refluxing ureteral reimplantation: A logical method for managing neonatal UVJ obstruction” Tom P.V.M. de Jong, Aart J. Klijn, Pieter Dik, Rafal Chrzan, Caroline F. Kuijper, Keetje de Mooij University Children’s Hospitals UMC Utrecht and AMC Amsterdam Utrecht, The Netherlands Correspondence to: T.P.V.M. de Jong, Head of Pediatric Urology, University Children’s Hospitals UMC Utrecht and AMC Amsterdam, Lundlaan 8, P.O. Box 85090, Utrecht, 3508AB, The Netherlands [email protected] (T.P.V.M. de Jong) Received 3 September 2014 Accepted 4 September 2014 Available online 4 February 2015
Kaefer et al. [1] advocate, in case an indication exists for surgical intervention, to turn an obstructive megaureter into a refluxing one as a temporary solution to avoid reimplant surgery in infants. They do this based on a concern that reimplant surgery should be avoided under the age of 12 months. No scientific proof exists to support this concern that for some people in pediatric urology is a dogma that they strictly adhere to. In contrast, ample scientific proof exists that infant recalibration and reimplantation can be done safely with good results and without any risk for the urodynamic properties of the bladder [2e5]. In this current series, the children are brought into a compromised situation twice because of the need for extra definitive reconstructive surgery at a later age. Therefore, in our opinion, the message should be: if one is not confident to do a major reconstruction in a neonate, refer the patient to a center where, regardless of age, the patient can be treated adequately in one step, instead of bringing the patient at risk by creating a refluxing megaureter. An obstructive megaureter is not an indication for any temporary measures except for a nefrostomy tube in case of a pus-filled system in a septic child or a cutaneous ureterostomy when severe doubts exist on the viability of the kidney, to observe whether
enough recovery in function of the obstructed kidney occurs. Furthermore, the combination of a megaureter with a hostile bladder in case of severe posterior urethral valves may be an indication for cutaneous ureterostomies, to overcome the time that the bladder needs to settle down.
References [1] Kaefer M, Misseri R, Frank E, Rhee A, Don Lee S. Refluxing ureteral reimplantation: a logical method for managing neonatal UVJ Obstruction. J Pediatr Urol 2014 oct;10(5):824e30. [2] de Kort LM, Klijn AJ, Uiterwaal CS, de Jong TP. Ureteral reimplantation in infants and children: effect on bladder function. J Urol 2002;167: 285e7. [3] Beganovic A, Klijn AJ, Dik P, De Jong TP. Ectopic ureterocele: long-term results of open surgical therapy in 54 patients. J Urol 2007;178: 251e4. [4] Hanna MK. Early surgical correction of massive refluxing megaureter in babies by total ureteral reconstruction and reimplantation. Urology 1981;18:562e6. [5] Matsumoto F, Tohda A, Shimada K. Effect of ureteral reimplantation on prevention of urinary tract infection and renal growth in infants with primary vesicoureteral reflux. Int J Urol 2004;11:1065e9.
DOI of original article: http://dx.doi.org/10.1016/j.jpurol.2014.01.027. http://dx.doi.org/10.1016/j.jpurol.2014.09.003 1477-5131/ª 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
