What are the predictive factors leading to ureteral obstruction following endoscopic correction of VUR in the pediatric population?

Chertin, Boris; Mele, Ermelinda; Kocherov, Stanislav; Zilber, Sofia; Nappo, Simona Gerocarni; Capozza, Nicola

doi:10.1016/j.jpurol.2018.04.021

Cited by 23 publications

(18 citation statements)

References 27 publications

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“…Treatment involved temporary ureteral stenting in one patient and ureteral reimplantation in the other. This is consistent with other series reporting post-operative ureteral obstruction rates of 0.5–1.05% after endoscopic injection (15, 17, 39). Patients in these series presented between 1 day and 49 months after surgery and were treated with ureteral stenting or reimplantation.…”

Section: Discussionsupporting

confidence: 93%

“…Patients in these series presented between 1 day and 49 months after surgery and were treated with ureteral stenting or reimplantation. High-grade VUR, obstructed/refluxing megaureter, inflamed urothelium, and secondary VUR have been associated with ureteral obstruction (17, 39). As shown here and elsewhere (16, 17), ureteral obstruction is a rare complication of endoscopic injection that may present years after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Among patients who initially had no VUR after Dx/HA injection, 13–26% were seen to have recurrence on subsequent voiding cystourethrogram (VCUG) 1–5 years after surgery (9, 14). Recent reports of delayed ureteral obstruction after Dx/HA have raised questions about the need for long-term monitoring of patients following endoscopic VUR treatment (15–17).…”

Section: Introductionmentioning

confidence: 99%

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Long-Term Clinical Outcomes and Parental Satisfaction After Dextranomer/Hyaluronic Acid (Dx/HA) Injection for Primary Vesicoureteral Reflux

et al. 2019

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Purpose: Endoscopic dextranomer/hyaluronic acid (Dx/HA) injection is a common treatment for vesicoureteral reflux (VUR) with excellent reported short-term clinical success rates. Long-term outcomes are less well-defined. We assessed long-term outcomes and parental satisfaction after Dx/HA injection for primary VUR with >5-year follow-up.Materials and Methods: Families of all patients who underwent Dx/HA injection for primary VUR at our institution between 2008 and 2012 were contacted for telephone interview. Data collected by phone included parental satisfaction and presence and severity of UTIs pre-operatively and post-operatively. Patient demographics, radiographic VUR data, need for secondary surgery, and surgical indications were obtained through chart review.Results: Five hundred and seventy-five patients underwent Dx/HA injection for primary VUR between 2008 and 2012. Ninety-nine (17.2%) of these patients' parents were successfully contacted and interviewed. Median follow-up time from surgery to survey was 8.4 (IQR 6.8–9.6) years. Secondary surgery was performed in 13/99 (13.1%), most commonly repeat Dx/HA injection. Seven patients (7.1%) underwent secondary Dx/HA injection for persistent VUR without UTIs at a median of 0.35 (IQR 0.33–0.77) years post-operatively. Five patients (5.1%) underwent Dx/HA injection (n = 3) or ureteral reimplantation (n = 2) for VUR with febrile UTIs (fUTIs) at a median of 2.2 (IQR 1.3–5.1) years. One patient had ureteral reimplantation for symptomatic obstruction 2.8 years after initial surgery. Only 3/99 (3.0%) required open or laparoscopic surgery after Dx/HA injection. Eighty-three families (84.7%) reported ≥1 fUTIs pre-operatively. Of these, only 9/83 (10.8%) reported fUTIs post-operatively, for an overall clinical success rate of 89.2%. Clinical success was 93.1% in patients whose pre-operative fUTIs were treated outpatient and 80.0% in those hospitalized at least once for fUTI treatment pre-operatively. Ninety-four percent of parents were highly satisfied, 2.4% partially satisfied, and 3.5% dissatisfied.Conclusions: Endoscopic injection with Dx/HA for primary VUR appears to have good long-term clinical success rates and high parental satisfaction, mirroring our previously reported short-term results. Post-operative ureteral obstruction is rare but may occur years post-operatively, justifying initial sonographic surveillance, and repeat imaging in symptomatic patients.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-Term Clinical Outcomes and Parental Satisfaction After Dextranomer/Hyaluronic Acid (Dx/HA) Injection for Primary Vesicoureteral Reflux

et al. 2019

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“…Possible risk factors, such as a preoperative bladder mucosal inflammation, the injection of greater volume and repeat injection were mentioned by several researchers but more investigation is warranted. 3 , 5 …”

Section: Discussionmentioning

confidence: 99%

Asymptomatic bilateral delayed ureteral obstruction following dextranomer/hyaluronic acid copolymer (Deflux) injection for vesicoureteral reflux.: A case report

Hoshino

Obara

Hoshii

et al. 2021

Urology Case Reports

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We here present a case of a 4-year-old girl who exhibited an asymptomatic bilateral de novo hydroureteronephrosis seven months after undergoing endoscopic treatment for bilateral vesicoureteral reflux. The child underwent an open bilateral reimplantation. Intraoperatively, a 14 mm nodule on the right and a 16 mm on the left located periureteral orifice were observed. When a small incision was made on nodules, a yellowish-white mucinous fluid flowed out.

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“…Demgegenüber stehen Studien mit konsequenten strukturierten Nachuntersuchungen, die eine Infektionsrate von 23 %, eine postoperative Komplikationsrate von 10 % und das Wiederauftreten eines Refluxes im Langzeitverlauf nach initial erfolgreicher Unterspritzung von 20 % beschreiben [10,16]. Während das verwendete Material für die Unterspritzung eher weniger Einfluss auf die Ergebnisse und die Komplikationen zu haben scheint, wirken sich neben einem hohen Refluxgrad v. a. niedriges Alter und eine vorausgegangene nicht erfolgreiche Behandlung ungünstig auf den Behandlungserfolg aus [19,20].…”

Section: Alternativen Zur Chemoprophylaxeunclassified

Antireflux-Operation im ersten Lebensjahr, wenn ja, wann und wie? Kontra OP

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2019

Aktuel Urol

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ZusammenfassungDas Management des vesikoureteralen Refluxes (VUR) im Säuglingsalter bleibt auch weiterhin ein überaus kontrovers diskutiertes Thema in der Kinderurologie. Hohe Spontanmaturationsraten selbst bei dilatierenden Refluxen von bis zu 45 %, der hohe Anteil an Jungen mit hohen Refluxgraden und oft assoziierter Nierenhypoplasie/Nierendysplasie von bis zu 30 % sowie die noch unreife Blasenfunktion kennzeichnen das Krankheitsbild in diesem Alter. Der Reflux per se hat in diesem Kontext eher an Bedeutung verloren. Umso erstaunlicher ist es, dass in letzter Zeit vermehrt Publikationen erscheinen, die eine endoskopische Therapie nicht nur als Alternative bei Durchbruchsinfektionen unter der Langzeittherapie, sondern auch als primäre Alternative zur Chemoprophylaxe empfehlen. Keine der bislang vorliegenden Metaanalysen konnte jedoch eine Evidenz für die Überlegenheit der endoskopischen Therapie gegenüber der Langzeitantibiose im Hinblick auf die Infekthäufigkeit oder die Entstehung neuer Parenchymnarben belegen. Demgegenüber stehen Nachteile dieser Methode wie die Notwendigkeit einer Narkose, die häufige Refluxpersistenz und das Obstruktionsrisiko sowohl postoperativ als auch im Langzeitverlauf. Die klassischen operativen Antireflux-Techniken sollten trotz moderner minimal invasiver Techniken aufgrund der hohen Spontanmaturationsrate und der in diesem Alter noch nicht abgeschlossenen Blasenfunktionsausreifung (sog. immature Blasenfunktion) auch weiterhin routinemäßig nicht zur Anwendung kommen und nur Einzelfällen vorbehalten bleiben

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What are the predictive factors leading to ureteral obstruction following endoscopic correction of VUR in the pediatric population?

Cited by 23 publications

References 27 publications

Long-Term Clinical Outcomes and Parental Satisfaction After Dextranomer/Hyaluronic Acid (Dx/HA) Injection for Primary Vesicoureteral Reflux

Long-Term Clinical Outcomes and Parental Satisfaction After Dextranomer/Hyaluronic Acid (Dx/HA) Injection for Primary Vesicoureteral Reflux

Asymptomatic bilateral delayed ureteral obstruction following dextranomer/hyaluronic acid copolymer (Deflux) injection for vesicoureteral reflux.: A case report

Antireflux-Operation im ersten Lebensjahr, wenn ja, wann und wie? Kontra OP

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