Urinary diversion in infants with primary high-grade vesicoureteric reflux, urinary sepsis and renal function impairment.
BACKGROUND
General consensus on the optimal treatment of septic infants with primary high-grade vesicoureteric reflux (VUR) and renal function impairment has not been reached. Our study aims at evaluating the role of temporary urinary diversion.


METHODS
Twenty male infants, affected by sepsis and primary high-grade VUR, underwent urinary diversion in 1996-2001 because of estimated risk of renal function deterioration, due to non-compliance with the antibiotic treatment. Plasmatic creatinine clearance, ultrasonography, micturition cystography and scintigraphy were evaluated.


RESULTS
Creatinine clearance was abnormal in 13 infants on admission, in 10 after urinary diversion and in 6 after second surgery. Renal damage (focal or diffuse) was evident in 16 patients, without modifications after surgery. No patient developed urinary tract infections (UTI). Vesicostomy was done in 12 cases, ureterostomy in 8. Nephrectomy was performed in 3 cases with poor renal function, and ureteroneocystostomy in 17.


CONCLUSIONS
Urinary diversion in septic infants with high-grade VUR can represent an alternative approach to the conservative or surgical treatment in selected patients presenting risk of renal function impairment. This procedure allowed an easy management of UTI without worsening of renal function while waiting for a better anatomical status to perform reconstructive surgery.
D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D051437:Renal Insufficiency / Q000150:complications / Q000601:surgery*; D018805:Sepsis / Q000150:complications; D014547:Urinary Diversion; D014552:Urinary Tract Infections / Q000150:complications / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000601:surgery*