Aim of the study was to analyse the success rate of endoscopic treatment (ET) using Dx/HA for primary vesicoureteral reflux (VUR) in children and to assess the incidence of postoperative urinary tract infections (UTIs).
We retrospectively reviewed the charts of 103 children with VUR grade II-V who underwent ET, including children with additional urogenital malformations. Outcomes were verified with voiding cystourethrography (VCUG) and periodical urinalysis.
103 children with a total of 174 ureters underwent ET. 71 patients presented with bilateral VUR. Additional malformations were: duplex ureters (19 patients), posterior urethral valves (PUV) (12 patients), diverticulum (4 patients), neurogenic bladder and ectopic orifice. VUR grade was II in 52, III in 74, IV in 41 and V in 7 ureters, respectively. Postoperative VCUG demonstrated no VUR in 140 ureters (80%) and diminished VUR grade in an additional 18 ureters (total 91%). After a second ET, VCUG was negative in 28 ureters. The overall success rate was 98%. 30 patients had had more than 3 febrile and 67 patients had had 1-3 febrile UTIs before ET. 4 out of 103 patients (3.9%) had 1 febrile UTI within the first year of follow-up. Serious complications after ET were not noted.
ET is effective at eliminating VUR in children, even in patients with high-grade reflux, as well as in patients with VUR and additional malformations. Early intervention may reduce the incidence of UTIs and prevent long-term renal damage.
[Show abstract][Hide abstract] ABSTRACT: To report our experience with ureteral obstruction after injection of dextranomer/hyaluronic acid copolymer (Dx/Ha) to treat vesicoureteral reflux, and analyze its possible causes, management and outcome.
Retrospective review of patients undergoing injection of Dx/Ha. The charts of patients with clinically relevant ureteral obstruction were evaluated for indications, prior interventions, technique of injection and volume injected. Video recordings obtained during injection were analyzed to detect possible technical errors.
Fifty-four patients (87 ureters) were treated with Dx/Ha injection in a 5-year period. Five ureters (5.7%) in five patients (9.3%) developed significant ureteral obstruction requiring intervention. Manifestations of obstruction included pain in two patients, urinary tract infections in one and loss of function in one. Increased serum creatinine was observed in a patient with a transplanted kidney. Four obstructions resolved spontaneously (two after percutaneous nephrostomy, two after placement of a ureteral stent) and one required reimplantation. Review of the videos did not reveal any deviation from the usual technique. The volumes injected in the obstructed cases (0.7-1.2 ml) were in the usual range.
In this series, the incidence of post Dx/Ha ureteral obstruction was higher than previously reported. Although 4/5 cases resolved spontaneously, they required drainage to relieve symptoms or to improve renal function. Surgeons need to be aware of this complication and include its possible occurrence in the informed consent obtained prior to injection.
[Show abstract][Hide abstract] ABSTRACT: Purpose:
We aimed to review patients with a solitary kidney and ipsilateral vesicoureteral reflux (VUR) who underwent endoscopic correction of VUR (ECVUR) and to evaluate the prevalence of obstruction in this group of patients.
Materials and methods:
We retrospectively reviewed the files of all patients who underwent ECVUR at our center between January 2000 and June 2011. Only patients with a solitary kidney and ipsilateral VUR were included.
Thirteen patients met our criteria. Two patients (15.38%) developed obstruction post-ECVUR. Both patients developed anuria in the first 24 h after surgery and required intervention. Two patients (15.38%) had increasing hydroureteronephrosis that was discovered on follow-up ultrasound, with no symptoms or signs of obstruction. Both were managed conservatively.
Our results showed a higher percentage of obstruction post-ECVUR in patients with a solitary kidney (15.38%), who required immediate intervention. Thus, we recommend giving clear instructions to parents of patients with VUR and a solitary kidney post-ECVUR before discharge from the hospital regarding decreased urine output and loin pain. We recommend a follow-up ultrasound to rule out obstruction and detect new-onset hydronephrosis.
[Show abstract][Hide abstract] ABSTRACT: There has been hesitancy to use dextranomer/hyaluronic acid copolymer (DHXA, Deflux for vesicoureteral reflux (VUR) in the setting of lower urinary tract (LUT) dysfunction because of the limited number of published studies, the possibility of less success, and the manufacturer's recommendations contraindicating its use in patients with active LUT dysfunction. We report on our experience using DXHA in this subset of patients whose VUR persisted despite targeted therapy for their LUT condition.
We reviewed patients diagnosed with both a LUT condition and VUR who underwent subureteric DXHA while still undergoing treatment for their LUT dysfunction. Persistence of VUR was confirmed by videourodynamic studies (VUDS)/VCUG (voiding cystourethrogram) and all patients were on targeted treatment (TT) and antibiotic prophylaxis prior to and during DXHA injection. VUR was reassessed post-injection.
Fifteen patients (22 ureters; 21F,1M) met inclusion criteria (mean age 6.1 years, range 4-12). Following one to three DXHA injections, VUR resolved in 17 ureters (77%) including eight of nine ureters in dysfunctional voiding (DV) patients, five of nine in idiopathic detrusor overactivity disorder (IDOD), and four of four in detrusor underutilization disorder (DUD) patients.
DXHA is safe and effective in resolving VUR in children with associated LUT dysfunction, even before their LUT condition has fully resolved. Highest resolution rates were noted in patients with either DV or DUD or who were least symptomatic prior to injection.
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