Evolving surgical management of pediatric vesicoureteral reflux: is open ureteral reimplantation still the ‘Gold Standard’?

Kirsch, Andrew J.; Arlen, Angela M.

doi:10.1590/s1677-5538.ibju.2020.99.05

Cited by 21 publications

(9 citation statements)

References 41 publications

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“…A range of factors have been shown to influence the resolution rate with endoscopic injection. Statistically significant effects on outcomes have been reported with VUR grade, injection technique, physician experience, patient age, and the extent of renal scarring at time of treatment ( 35 , 106 – 108 ). In addition, high UDR values have been associated with reduced likelihood of VUR resolution following endoscopic injection ( 109 ).…”

Section: Treatment Approachesmentioning

confidence: 99%

“…In all patients with VUR, there is a need to balance risks, benefits and costs of treatment vs. risks (particularly to the kidneys) of not treating the condition ( Figure 2 ) ( 14 , 33 , 35 , 151 ). We believe that first-line endoscopic injection is preferable for many VUR patients requiring intervention.…”

Section: Management Recommendationsmentioning

confidence: 99%

“…There are four main options for managing patients with VUR: observation, antibiotic prophylaxis, endoscopic injection and ureteral reimplantation ( 33 – 35 ).…”

Section: Introductionmentioning

confidence: 99%

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Management of Vesicoureteral Reflux: What Have We Learned Over the Last 20 Years?

et al. 2021

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Vesicoureteral reflux (VUR) is associated with increased risks of urinary tract infection, renal scarring and reflux nephropathy. We review advancements over the last two decades in our understanding and management of VUR. Over time, the condition may resolve spontaneously but it can persist for many years and bladder/bowel dysfunction is often involved. Some factors that increase the likelihood of persistence (e.g., high grade) also increase the risk of renal scarring. Voiding cystourethrography (VCUG) is generally considered the definitive method for diagnosing VUR, and helpful in determining the need for treatment. However, this procedure causes distress and radiation exposure. Therefore, strategies to reduce clinicians' reliance upon VCUG (e.g., after a VUR treatment procedure) have been developed. There are several options for managing patients with VUR. Observation is suitable only for patients at low risk of renal injury. Antibiotic prophylaxis can reduce the incidence of UTIs, but drawbacks such as antibiotic resistance and incomplete adherence mean that this option is not viable for long-term use. Long-term studies of endoscopic injection have helped us understand factors influencing use and the effectiveness of this procedure. Ureteral reimplantation is still performed commonly, and robot-assisted laparoscopic methods are gaining popularity. Over the last 20 years, there has been a shift toward more conservative management of VUR with an individualized, risk-based approach. For continued treatment improvement, better identification of children at risk of renal scarring, robust evidence regarding the available interventions, and an improved VUR grading system are needed.

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Section: Treatment Approachesmentioning

confidence: 99%

Section: Management Recommendationsmentioning

confidence: 99%

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Management of Vesicoureteral Reflux: What Have We Learned Over the Last 20 Years?

et al. 2021

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“…Established open surgery procedures are now increasingly competing with their minimally invasive implementations. The aim of future surgical standards must be to prevent pyelonephritis safely and reproducibly, while causing little surgical trauma and minimal postoperative morbidity, and maintaining a high level of acceptance by the parents of children with VUR [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Vesicoscopic Cross-Trigonal Ureteral Reimplantation for Vesicoureteral Reflux: Intermediate Results

Kruppa¹,

Fitze²,

Schuchardt³

2022

Children

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For the treatment of vesicoureteral reflux, the introduction of vesicoscopic procedures offers new perspectives for improving patient comfort and quality. Our aim was to examine whether minimally invasive vesicoscopic cross-trigonal ureteral reimplantation (VCUR) would meet expectations. Between 2012 and 2021, 99 girls and 35 boys with high-grade vesicoureteral reflux (VUR) underwent VCUR. For two boys, we failed to establish the pneumovesicum, leading to conversion to open surgery. The mean age was 4.5 years, ranging from 10 months to 18 years. VCUR was successfully performed in 132 patients, including 75 patients with bilateral VUR and 12 children with double ureters with unilateral or bilateral VUR, corresponding to a total of 229 operated ureters. The mean time of operation was 151 min for all patients. There were no perioperative complications, with the exception of three cases of pneumoperitoneum without consequences. Postoperatively, we recognized three cases of acute hydronephrosis, two of them required transient drainage. Three patients developed extravasation of urine after the postoperative removal of the transurethral catheter, rapidly resolved by new drainage. In two patients, we combined VCUR with laparoscopic heminephrectomy and opposite laparoscopic nephrectomy, respectively. Overall, mean postoperative hospital stay was 4.2 days. We observed recurrent VUR in seven ureters, resulting in a success rate for VCUR of 96.9%. These results demonstrate the feasibility of VCUR and its potential to displace open surgery with high safety and wide applicability.

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“…Vesicoureteral re ux (VUR) is regarded as one of the more commonly reported congenital disorders of the urinary system. Albeit the exact prevalence of VUR remains to be elucidated due the often-asymptomatic nature of the disease, it is estimated that VUR affects around 0.4-1.8% of otherwise healthy children globally (1)(2)(3). Recurrent urinary tract infection associated with high grade re ux predispose to kidney parenchymal scar and subsequently lead to proteinuria, hypertension, growth impairment and chronic kidney disease (CKD) (4).…”

Section: Introductionmentioning

confidence: 99%

Long-Term Outcome of Cohen Vs. Gil-Verent Methods in The Treatment 0f Vesicoureteral Reflux

Hosseini¹,

Mahdavynia

Hooman

et al. 2022

Preprint

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Introduction: The vesicoureteral reflux (VUR) is among the most common congenital disorder of urinary system. There are several surgical methods to manage this disease. In this study we aimed to assess and compare the result of the two common surgical techniques including Cohen and Gil-Vernet methods of in children with VUR.Method and materials: In this retrospective study, we gathered the record of all patients who underwent Cohen or Gil-Vernet surgeries during 2010-2017. We recruited all the infants and patients until age of 15 years who had moderate and high grade VUR in voiding cystourethrogram (VCUG). We gathered and compared information regarding the grade of VUR, the number of breaks through urinary tract infection (UTI), kidney parenchymal scars and the side effects of surgery between two methods. Results: In this study we recruited 89 patients with mean age of 66.56 ± 31.51months. Of all patients, 18 cases underwent Cohen surgery and for 71 patients Gil-Vernet was performed. All the patients showed improvement regarding the grade of reflux according to VCUG (p:.001). The incidence rate of UTI was decreased in both groups (p:0.001). The clinical profile of the study participants was improved in both group and there was not any difference between two surgical modalities in this respect. The mean follow-up time was 59.11 ± 23.4 months.Conclusion: Both Cohen or Gil-Vernet surgeries were effective methods for treating VUR. Also, there was not any significant difference between two surgical techniques.

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Evolving surgical management of pediatric vesicoureteral reflux: is open ureteral reimplantation still the ‘Gold Standard’?

Cited by 21 publications

References 41 publications

Management of Vesicoureteral Reflux: What Have We Learned Over the Last 20 Years?

Management of Vesicoureteral Reflux: What Have We Learned Over the Last 20 Years?

Vesicoscopic Cross-Trigonal Ureteral Reimplantation for Vesicoureteral Reflux: Intermediate Results

Long-Term Outcome of Cohen Vs. Gil-Verent Methods in The Treatment 0f Vesicoureteral Reflux

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