Abstract
Objectives
To report our experience with endoscopic management of vesicoureteral reflux (VUR) by injection of a tissue bulking substance–Dextranomer/ hyaluronic acid copolymer at vesicoureteric junction.
Design
Retrospective analyses of case records.
Setting
Pediatric Surgery department in a tertiary care government Institute.
Participants
500 children (767 renal units) consecutively referred to the out-patient department with vesicoureteral reflux noted on micturating cysto-urethrogram (MCU) over a period of 13 years (2004-2016).
Intervention
Preoperative VUR grading and renal scars on radionuclide scans were documented. Dextranomer hyaluronic acid copolymer was injected through a cystoscope at the vesicoureteral junction as a day care procedure under short anesthesia. Patients were followed (average duration 27.3 mo) with clinical assessment, periodic urine cultures and renal scans.
Main outcome measure
Cessation of VUR and symptomatic relief / clinical success postoperatively at 3 months.
Results
Complete symptomatic relief was obtained in 482 (96.4%) patients. In 681 units where MCU was available, 614 (90%) units showed resolution of VUR.
Conclusion
Endoscopic injection of tissue bulking substances at vesicoureteric junction to stop VUR seems to be an effective intervention
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References
RIVUR Trial Investigators, Hoberman A, Greenfield SP, Mattoo TK, Keren R, Mathews R, Pohl HG, et al. Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med. 2014;370:2367–76.
Prisca RA, Gozar H, Prisca AM, Moldovan C, Borda A. Parent compliance: A bad predictor of resolution and a problem in the application of EAU guidelines on vesicoureteral reflux in children. Int Urol Nephrol. 2017;49:741–5.
Puri P, Chertin B, Velayudham M, Dass L, Colhoun E. Treatment of vesicoureteral reflux by endoscopic injection of dextranomer/hyaluronic acid copolymer: preliminary results. J Urol. 2003;170:1541–4.
Puri P, Pirker M, Mohanan N, Dawrant M, Dass L, Colhoun E. Subureteral dextranomer/hyaluronic acid injection as first line treatment in the management of high grade vesicoureteral reflux. J Urol. 2006;176:1856–9.
Lendvay TS, Sorensen M, Cowan CA, Joyner BD, Mitchell MM, Grady RW. The evolution of vesicoureteral reflux management in the era of dextranomer/hyaluronic acid copolymer: A pediatric health information system database study. J Urol. 2006;176:1864–7.
Cerwinka WH, Grattan–Smith JD, Scherz HC, Kirsch AJ. Appearance of Deflux implants with magnetic resonance imaging after endoscopic treatment of vesicoureteral reflux in children. J Pediatr Urol. 2009;5:114–8.
Capozza N, Caione P. Role of the endoscopic treatment of vesicoureteal reflux. A 16–years’ experience. Minerva Pediatr. 2003;55:607–14.
Chandrasekharam VV. Endoscopic treatment of vesicoureteric reflux with dextranomer/hyaluronic acid copolymer (Deflux): Single–surgeon experience with 48 ureters. Indian J Urol. 2013;29:173–6.
Verma A, Panda SS, Bajpai M. Role of endoscopic treatment of vesico–ureteric reflux in downgrading renin angiotensin system activation. J Pediatr Urol. 2014;10:386–90.
Lavelle MT, Conlin MJ, Skoog SJ. Subureteral injection of Deflux for correction of reflux: analysis of factors predicting success. Urology. 2005;65:564–7.
Garge S, Menon P, Rao KLN, Bhattacharya A, Abrar L, Bawa M, et al. Vesicoureteral reflux: Endoscopic therapy and impact on health related quality of life. J Indian Assoc Pediatr Surg. 2013;18:11–5.
Nortes Cano L, Zambudio Carmona G, Guirao Pinera MJ, Ruiz Jimenez JI. Endoscopic treatment of primary vesicoureteral reflux in childhood. Review of 989 cases in a 9 years period. Cir Pediatr. 2008;21:173–80.
Chertin B, Natsheh A, Fadeev D, Shenfeld OZ, Farkas A. Unilateral vesicoureteral reflux and history of contralateral vesicoureteral reflux warranting routine bilateral endoscopic correction. J Urol. 2008;180:1601–3
Vandersteen DR, Routh JC, Kirsch AJ, Scherz HC, Ritchey ML, Shapiro E, et al. Postoperative ureteral obstruction after subureteral injection of dextranomer/hyaluronic acid copolymer. J Urol. 2006;176:1593–5.
Boudaoud N, Line A, Pons M, Lefebvre F, Bouche Pillon MA, Francois C, et al. Secondary megaureter: A rare complication of Deflux® endoscopic management of vesicoureteral reflux in children. Arch Pediatr. 2017;24:249–53.
Yankovic F, Swartz R, Cuckow P, Hiorns M, Marks SD, Cherian A, et al. Incidence of Deflux® calcification masquerading as distal ureteric calculi on ultrasound. J Pediatr Urol. 2013;9:820–4.
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Rao, K., Menon, P., Samujh, R. et al. Endoscopic Management of Vesicoureteral Reflux and Long-term Follow-up. Indian Pediatr 55, 1046–1049 (2018). https://doi.org/10.1007/s13312-018-1439-5
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DOI: https://doi.org/10.1007/s13312-018-1439-5