Antirefluxoperation im ersten Lebensjahr, wenn ja, wann und wie? − Pro OP

Zusammenfassung

Eine offene chirurgische Intervention im ersten Lebensjahr bei Kindern mit VUR ist nur in Ausnahmefällen indiziert. V. a. männliche Säuglinge mit hochgradigem Reflux, Einschränkung der Nierenfunktion im Sinne einer Refluxnephropathie, eindeutiger infravesikaler Obstruktion, fieberhaften Durchbruchsinfekten im Sinne von Pyelonephritiden oder septischen Zustandsbildern bedürfen einer frühzeitigen chirurgischen Intervention. Diese beschränkt sich neben der zu empfehlenden Zirkumzision meist auf die endoskopische infravesikale Desobstruktion von Urethralklappen, prolabierenden Ureterozelen sowie sekundären Blasenhalsobstruktionen. Eine endoskopische Refluxtherapie mit Hyaluronsäure/Dextranomer ist lediglich als „down-staging“ des VUR aufzufassen, sie muss individuell indiziert werden, eine offene, suprapubische Entlastung des Harntraktes im Sinne einer Vesikostomie oder Ureterocutaneostomie ist nur mehr in Einzelfällen bei septischen Zuständen oder nicht durchführbarer endoskopischer Therapie berechtigt.

Abstract

Surgical intervention in children with VUR is rarely indicated in the first year of life. Early surgical intervention is primarily required for male infants with a high-grade reflux, renal impairment due to reflux nephropathy, infravesical obstruction and breakthrough infections like pyelonephritis or urosepsis. Besides the recommended circumcision, this is usually limited to endoscopic infravesical disobstruction of posterior urethral valves, prolapsing ureteroceles or secondary bladder neck obstructions. Concomitant endoscopic reflux therapy with bulking agents such as hyaluronic acid/dextranomer should be regarded as a downstaging of the VUR; the decision should be made on an individual basis. Urinary diversion, e. g. vesicostomy or ureterocutaneostomy, is only required in exceptional cases.

Schlüsselwörter

vesikoureteraler Reflux - Säuglinge männlich - infravesikale Obstruktion - endoskopische Refluxtherapie - Refluxdownstaging

Keywords

male infants - infravesical obstruction - downstaging of reflux - vesicoureteral reflux - endoscopic reflux therapy

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