Clinical Outcomes and Long-Term Resolution in Patients with Persistent Vesicoureteral Reflux After Open Ureteral Reimplantation

Hubert, Katherine C.; Kokorowski, Paul; Huang, Lin; Prasad, Michaella M.; Rosoklija, Ilina; Retik, Alan B.; Nelson, Caleb P.

doi:10.1016/j.juro.2012.03.048

Cited by 18 publications

(13 citation statements)

References 14 publications

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“…The patient characteristics revealed that 60% of the patients were female, 66% had bilateral disease, 70% had scarred kidneys and more than 20% had history of previous endoscopic injection. These figures are in accordance with the literature and indications for open surgery (8).…”

Section: Discussionsupporting

confidence: 92%

“…However, the surgical success rates didn't differ regarding the surgical technique. Unlike the endoscopic injection techniques (10), success of open UNC does not seem to be affected by the grade of reflux or the presence of voiding dysfunction (8,11,12). Similarly, our results revealed that UNC had a constant success rate regardless of the grade of VUR, presence of voiding dysfunction and also was not affected by the number of the preoperative breakthrough infections, presence of renal scar or the age of the patient.…”

Section: Discussionsupporting

confidence: 58%

“…Long term results of endoscopic technique yielded a reflux recurrence rate of about 25% (14)(15)(16)(17). However, in patients who underwent a successful UNC, recurrence is an extremely rare event and persistent vesicoureteral reflux after reimplantation resolves spontaneously in most children and can be managed non-operatively with good long-term outcomes (8). Therefore, current practice is not to perform routine postoperative VCUG.…”

Section: Discussionmentioning

confidence: 99%

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Ureteroneocystostomy in primary vesicoureteral reflux: critical retrospective analysis of factors affecting the postoperative urinary tract infection rates

et al. 2014

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ARTICLE INFO ______________________________________________________________ ______________________Introduction: To determine the parameters affecting the outcome of ureteroneocystostomy (UNC) procedure for vesicoureteral reflux (VUR). Materials and Methods:Data of 398 patients who underwent UNC procedure from 2001 to 2012 were analyzed retrospectively. Different UNC techniques were used according to laterality of reflux and ureteral orifice configuration. Effects of several parameters on outcome were examined. Disappearance of reflux on control VCUG or absence of any kind of UTI/symptoms in patients without control VCUG was considered as clinical improvement.Results: Mean age at operation was 59.2 ± 39.8 months and follow-up was 25.6 ± 23.3 months. Grade of VUR was 1-2, 3 and 4-5 in 17, 79, 302 patients, respectively. Male to female ratio was 163/235. UNC was performed bilaterally in 235 patients and intravesical approach was used in 373 patients. The frequency of voiding dysfunction, scar on preoperative DMSA, breakthrough infection and previous surgery was 28.4%, 70.7%, 49.3% and 22.4%, respectively. Twelve patients (8.9%) with postoperative contralateral reflux were excluded from the analysis. Overall clinical improvement rate for UNC was 92%. Gender, age at diagnosis and operation, laterality and grade of reflux, mode of presentation, breakthrough infections (BTI) under antibiotic prophylaxis, presence of voiding dysfunction and renal scar, and operation technique did not affect the surgical outcome. However, the clinical improvement rate was lower in patients with a history of previous endoscopic intervention (83.9% vs. 94%). Postoperative UTI rate was 27.2% and factors affecting the occurrence of postoperative UTI were previous failed endoscopic injection on univariate analysis and gender, preoperative BTI, postoperative VUR state, voiding dysfunction on multivariate analysis. Surgery related complication rate was 2% (8/398). These were all low grade complications (blood transfusion in 1, hematoma under incision in 3 and prolonged hospitalization secondary to UTI in 4 patients).In long term, 12 patients are under nephrologic follow-up because of hypertension in 5, increased serum creatinine in 5, proteinuria in 1 and hematuria in 1 patient and all these patients had preoperative scarred kidneys. Conclusions: Despite its invasive nature, UNC has a very high success rate with a negligible percent of complications. In our cohort, the only factor that negatively affected the clinical improvement rate was the history of previous antireflux interventions where the predictive factors for postoperative UTI were previous failed endoscopic injection, female gender, preoperative BTI, persistent VUR and voiding dysfunction.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

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Ureteroneocystostomy in primary vesicoureteral reflux: critical retrospective analysis of factors affecting the postoperative urinary tract infection rates

et al. 2014

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“…While we did not repeat VCUG in any patient with persistent VUR, studies suggest that the natural history is eventual resolution ( 21 ). Hubert et al ( 25 ) reported persistent VUR in 27.8% of their cohort, with spontaneous resolution in all cases that were grade 1. In our series, all 4 cases of persistent VUR were grade 1 ( 24 ).…”

Section: Discussionmentioning

confidence: 88%

Unilateral extravesical ureteral reimplantation via inguinal incision for the correction of vesicoureteral reflux: a 10-year experience

Yap¹,

Nseyo²,

Din³

et al. 2017

Int. braz j urol.

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Introduction and Objective:Multiple options exist for the surgical management of vesicoureteral reflux (VUR). We report on our 10-year experience using the inguinal approach to extravesical ureteral reimplantation (EVR).Materials and Methods:Patient characteristics of age, gender, and reflux grade were obtained and outcomes of operative time, hospital stay, and radiographic resolution were assessed.Results:71 girls and 20 boys with a mean age of 74 months (range 14-164) underwent inguinal EVR via a 3.5-cm inguinal mini-incision. Mean follow up was 10.9 months (range 0.4-69.7). Average grade of reflux was 2.80. Average operative time was 91 minutes (range 51-268). The procedure was successful in 87 of 91 patients (95.6%). The 3 cases of reflux that persisted were all grade 1 and managed expectantly. Contralateral reflux developed in 9 cases, all of which resolved after treatment with either Deflux or ureteral reimplant. There were 4 case of urinary retention that resolved after a brief period of CIC or indwelling catheterization. There were no cases of ureteral obstruction. Most patients were discharged on post-operative day 1 (85/91) and no hospitalization extended beyond 3 days.Conclusions:The inguinal approach to extravesical ureteral reimplantation should be considered as a potentially minimally invasive alternative to endoscopic and robotic treatment of VUR with a success rate more comparable to traditional open approaches. We feel it is the method of choice in cases of unilateral VUR requiring surgical correction.

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“…Currently, the published data are conflicting regarding the complication profile of RALUR [7e10] with multi-institutional pooled data demonstrating high rates of persistent reflux and reoperation [10], whereas a large prospective single-surgeon series reported no complications [11]. This exists in comparison to OUR, which has a robust literature of favorable short and long-term outcomes and low complication rates [12,13]. Similarly, direct costs have increased with use of robot-assisted technology [6].…”

Section: Introductionmentioning

confidence: 99%

Robotic versus open pediatric ureteral reimplantation: Costs and complications from a nationwide sample

Kurtz

Leow

Varda

et al. 2016

Journal of Pediatric Urology

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Clinical Outcomes and Long-Term Resolution in Patients with Persistent Vesicoureteral Reflux After Open Ureteral Reimplantation

Cited by 18 publications

References 14 publications

Ureteroneocystostomy in primary vesicoureteral reflux: critical retrospective analysis of factors affecting the postoperative urinary tract infection rates

Ureteroneocystostomy in primary vesicoureteral reflux: critical retrospective analysis of factors affecting the postoperative urinary tract infection rates

Unilateral extravesical ureteral reimplantation via inguinal incision for the correction of vesicoureteral reflux: a 10-year experience

Robotic versus open pediatric ureteral reimplantation: Costs and complications from a nationwide sample

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