Implications of paraureteral diverticulum for the management of vesicoureteral reflux

Abstract

OBJECTIVES: 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.