title: Implications of paraureteral diverticulum for the management of vesicoureteral reflux.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Pediatric Urology, Severance Children's Hospital, Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young Jae
authors.initials: YJ
authors.lastname: Im
authors.affiliation: Department of Pediatric Urology, Severance Children's Hospital, Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Yong Seung
authors.initials: YS
authors.lastname: Lee
authors.affiliation: Department of Pediatric Urology, Severance Children's Hospital, Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sang Woon
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Department of Pediatric Urology, Severance Children's Hospital, Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Han
mesh_terms: D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D004240:Diverticulum / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D014515:Ureteral Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D014552:Urinary Tract Infections / Q000209:etiology*; D014718:Vesico-Ureteral Reflux / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*
chemical_list: D003287:Contrast Media
keywords: bladder; diverticulum; ureter; urinary tract infection; vesicoureteral reflux