Efficacy of Bladder Ultrasound in Prediction of Resolution of Vesicoureteral Reflux After Endoscopic Subureteral Hyaluronic Acid/Dextranomer (Deflux) Injection

Abstract

BACKGROUND: We evaluated the e cacy of bladder ultrasound to predict resolution of vesicoureteral re ux after subureteral endoscopic Hyaluronic acid/dextranome (De ux) injection. METHODS: Between 2010 and 2018, 120 patients (220 ureters) underwent Subureteral De ux injection for re ux in children. Male/female ratio was 1: 5. All patients had voiding cystourethrography and bladder ultrasound at 3 months and one year after surgery. Outcome analysis included: Success rates and presence/ absence of De ux mount by bladder ultrasound.RESULTS: Mean follow-up was 48 months. Mean age at surgery 72 months. Grades of re ux were grade II in 100 ureters (45.4%), III in 90 ureters (41%) and IV-V in 30 ureters (13.6%). Bilateral surgery was performed in 40 patients. Single De ux injection cured re ux (Success rate) in 85% (187 ureters) at 3 months which improved to 88.2% (194 ureters) at last follow-up. Ultrasound was able to detect De ux mounts at the base of the bladder in 200 ureters (91%). Sensitivity and speci city of ultrasound was 92.68% and 20% of the correction of re ux at the last follow up. Positive Predictive Value of bladder ultrasound was 94 % and accuracy was 87.7 % at the last follow up. Ultrasound did not detect the mount in 20 ureters (9 %) and 8 of these ureters (3.6%) had persistence of their re ux. Ultrasound was able to detect bilateral mounts as well as unilateral mounts.CONCLUSION: Bladder-US was highly sensitive for detection of De ux implants and can predict resolution of re ux in 82.7% of re uxing ureters. Postoperative bladder-US could be adjusted as a screening tool in the follow-up of patients with primary low-grade VUR patients treated by De ux injection, while VCUG could be preserved for follow-up of high-grade VUR patients.

Does Autologous Blood Injection Following Dextranomer/Hyaluronic Acid Copolymer Implantation in Treating Vesicoureteral Reflux Affect the Microsphere Particle Leakage?

“…Arlen et al also suggested that postoperative VCUG could be safely avoided in the majority of children undergoing endoscopic treatment of primary VUR [23]. Bladder ultrasonography is highly sensitive for detecting Deflux ® implants and can anticipate the resolution of reflux with an accuracy of 88.95% in low-grade VUR and 36.67% in high-grade VUR [24]. Postoperative bladder ultrasonography could be modified as a screening tool in the follow up of patients with a primary low-grade VUR treated by Deflux ® injection, while VCUG could be used for the follow up of high-grade VUR patients [24].…”

“…Bladder ultrasonography is highly sensitive for detecting Deflux ® implants and can anticipate the resolution of reflux with an accuracy of 88.95% in low-grade VUR and 36.67% in high-grade VUR [24]. Postoperative bladder ultrasonography could be modified as a screening tool in the follow up of patients with a primary low-grade VUR treated by Deflux ® injection, while VCUG could be used for the follow up of high-grade VUR patients [24]. In our setting, we used a radionuclide cystogram to follow the resolution of vesicoureteral reflux in our patients.…”

Correlation of Renal Scarring to Urinary Tract Infections and Vesicoureteral Reflux in Children

“…The type of surgery was chosen according to the renal function, laterality, and grade of VUR. Surgical options included extravesical ureteral reimplantation for high-grade reflux (grade IV–V) and endoscopic subureteral hyaluronic acid/dextranome (deflux) injection for low-grade reflux (grade I–III) as a double HIT technique [ 11 ]. Grade I is injected when there is a deterioration of reflux with an increasing grade of hydronephrosis.…”