title: The management of vesicoureteral reflux in the setting of posterior urethral valve with emphasis on bladder function and renal outcome: a single center cohort study.
abstract: OBJECTIVE
  To represent our experience in the management of posterior urethral valves and concomitant vesicoureteral reflux (VUR).
  
  
  METHODS
  A total of 326 children with posterior urethral valve who had underwent valve ablation/bladder neck incision were studied, and those who had persistent VUR and were categorized under 3 main groups were followed up. Group 1 (n = 71) received prophylactic antibiotic, group 2 (n = 50) underwent Deflux injection (2a) (n = 28): Deflux injection alone, group 2b (n = 22) Deflux with concomitant autologous blood injection (HABIT), and group 3 (n = 19) underwent ureteroneocystostomy before referral and was followed up conservatively. VUR resolution, incidence of urinary tract infections (UTI), and bladder function were assessed.
  
  
  RESULTS
  Mean duration of follow-up was 3.8 years; VUR resolution occurred in 66.1%, 86.0%, and 94.0% of groups 1-3, respectively (P = .013). Resolution rate in group 2b was significantly higher than group 2a (90.9% vs 78.5%). Patients in group 2 experienced a longer UTI-free period compared with others (P <.05). Urodynamic studies demonstrated significant decrease in maximum voiding detrusor pressure and detrusor overactivity in all groups (P <.001). Children in group 3 ended up with lower compliance compared with others (P <.001). After toilet training, only 2.8%, 21.4%, 13.6%, and 27% children were diagnosed with lower urinary tract dysfunction in groups 1-3, respectively (P = .027). Myogenic failure developed only in 3 boys in group 3.
  
  
  CONCLUSIONS
  Ablation/bladder neck incision leads to significant improvement in VUR status in part because of improvement in bladder function. After successful valve removal, conservative therapy can be regarded as the mainstay of reflux treatment, whereas HABIT is recommended for high grade VUR associated with febrile UTI or deterioration in renal function.
authors.affiliation: Division of Pediatric Urology, Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Ali
authors.initials: A
authors.lastname: Tourchi
authors.affiliation: Pediatric Urology Research Center, Section of Tissue Engineering and Stem Cell Therapy, Department of Pediatric Urology, Children's Pediatric Center of Excellence, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: kajbafzd@sina.tums.ac.ir.
authors.forename: Abdol-Mohammad
authors.initials: AM
authors.lastname: Kajbafzadeh
authors.affiliation: Pediatric Urology Research Center, Section of Tissue Engineering and Stem Cell Therapy, Department of Pediatric Urology, Children's Pediatric Center of Excellence, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Aryan
authors.affiliation: Pediatric Urology Research Center, Section of Tissue Engineering and Stem Cell Therapy, Department of Pediatric Urology, Children's Pediatric Center of Excellence, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Ebadi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D006801:Humans; D007223:Infant; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D012189:Retrospective Studies; D014521:Urethra / Q000002:abnormalities* / Q000601:surgery*; D001743:Urinary Bladder / Q000503:physiopathology*; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*