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Urinary and Genital Disorders (Children)

Deflux and Reimpantation Surgery

03/04/2010

Question:

My daughter is now 3 with reflux being diagnosed at age 2. She is grade 4 and 5 with renial swelling and one kidney smaller that the other. We had delfux done in August. Didn`t work, she is now scheduled for reimplantation in March. I am curious what happens to the delux and will it cause complications to her reimplantation? I am not sure if we should wait, is it to soon?? Is it better to have her cut open or laprascopoy?? Should I wait until she is 5??? I am very reluctant to do this I am not very trusting and was against delux from the start.

Answer:

First of all, it is important to be comfortable with any recommendation for surgical treatment. Deflux injection is a nice minimally invasive option, but does not correct reflux as often as open surgery.

Having had Deflux injection does not make it more difficult to perform open surgery. The Deflux implant is removed.

There are two methods of performing open and laparoscopic surgery for correction of reflux. One method stays outside the bladder and the other is performed within the bladder. Both methods are equally effective in correcting reflux. However, the method in which the ureter is reimplanted outside the bladder may result in difficulty voiding for a period of time if both ureters are reimplanted at the same time; in fact, some babies are discharged from the hospital with a catheter draining the bladder because the child cannot urinate. When the reflux is corrected within the bladder, the success rate is also very high and permanent, but many have significant discomfort with urination for 5 to 7 days after the surgery.

The previous paragraph is intended to provide a realistic appraisal of what to expect after a 3-year-old child undergoes open or laparoscopic reimplant surgery. The advantage of the laparoscopic approach is the smaller incisions and possibly less postoperative discomfort. Waiting until 5 years of age will not change these risks significantly.

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Response by:

Jack S Elder, MD, FACS, FAAP Jack S Elder, MD, FACS, FAAP
Clinical Professor of Urology
School of Medicine
Case Western Reserve University