J. Christopher Austin

“ Typically, the grade of VUR is an important factor for predicting resolution and risk of renal scarring; however, in postpubertal patients it has not been studied as extensively. It is expected that the rates of spontaneous resolution will be lower after puberty.
5. Surgical Treatment of VUR after Puberty One of the more humbling experiences for a pediatric urologist is their first ureteral reimplantation done on a female after puberty. These difficulties start as females approach puberty. During puberty, the pelvis widens and deepens in the female. ”

“ It remains unknown as to whether patients experiencing continued problems with UTIs after surgery would have fewer problems if they had not undergone surgery.
4. Which Patients Should Be Evaluated and Treated? The incidence of VUR after puberty is significantly lower than in young infants with febrile UTIs [1] . It has been well established that VUR is a risk factor for pyelonephritis and that it frequently is present as one of several risk factors for UTIs. Voiding dysfunction must always be considered in this patient population and treated appropriately. ”

“ Both intra- and extra-vesical laparoscopic techniques for reimplantation have been described in children [26] [27] [28] . In the postpubertal female, the advantage for laparoscopy is that the scope and instruments can reach deep into the pelvis with good visualization. ”

“ At a mean follow-up of 14 months, none of the patients had further infections or symptoms. In children, the treatment of VUR with D/HA injections has been associated with a lower incidence of UTIs postoperatively [25] . It is unknown whether or not postpubertal patients are at the same risk for late failures of endoscopic injection as was described in some of the original series of children.
8. Laparoscopic and Robotic Ureteral Reimplantation Minimally invasive ureteral reimplantation for VUR has been performed for over a decade; however its widespread uses have been slow to spread. ”

“ The size and body mass index will play a role with obese patients creating more difficulties with exposure. Proper surgical planning and the use of larger and more flexible fixed retractors such as a Bookwalter rather than the Denis-Browne retractor will facilitate the procedure. ”