The Management of Vesicoureteral Reflux in Children with Myelodysplasia

We treated systematically 36 children with myelodysplasia and vesicoureteral reflux in an attempt to control infection, eliminate reflux and preserve renal function without diversion. The reflux resolved in 9 of 21 children on intermittent catheterization and remained stable without recurrent infection in an additional 7. Cutaneous vesicostomy in 6 infants temporarily eliminated reflux in 3. Ureteral reimplantation was performed in 11 children (17 ureters) and was successful in all. Transureteroureterostomy was done in 2 children. External sphincterotomy failed to cure reflux in 5 children. Five infants with mild grades of reflux were managed expectantly and 1 had spontaneous resolution of the reflux. Over-all, this systematic approach resulted in cure in 23 patients (64 per cent), stable but persistent reflux without recurrent infection or renal deterioration in 11 (30 per cent) and failure in 2 (6 per cent). No child required urinary diversion. The indications for each treatment modality are discussed.