Endoscopic Treatment of Primary Grades IV and V Vesicoureteral Reflux in Children With Subureteral Injection of Polytetrafluoroethylene

Chertin, Boris; Caluwé, D. De; Puri, Prem

doi:10.1097/01.ju.0000062300.71507.3a

Cited by 47 publications

(24 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…15 En 2003 se presentó un trabajo 16 sobre los resultados a largo plazo y el seguimiento a los 17 años de 717 casos con uréteres con RVU de alto grado (IV y V); del total, sólo 9 pacientes (1,2%) presentaron recidiva de RVU, lo que confirma por qué este material es considerado, por numerosos autores, la primera opción en caso de RVU de alto grado. A pesar de los resultados a largo plazo del PTFE, los datos sobre la posible migración de sus partículas no pueden ignorarse y, por esta razón, se han buscado y experimentado otras sustancias inyectables.…”

Section: Reflejo Vesicoureteral Tratamiento Endoscópico / 351unclassified

Reflujo vesicoureteral. Tratamiento endoscópico

et al. 2013

View full text Add to dashboard Cite

Arch Argent Pediatr 2013;111(4):349-352 / 349 RESUMEN El reflujo vesicoureteral (RVU) es el flujo de orina desde la vejiga hasta el tracto urinario superior. Está presente en el 25% al 70% de los niños con infección urinaria asociada a pielonefritis. Se realizó una revisión de la bibliografía sobre el tratamiento endoscópico del RVU analizando las técnicas, los materiales utilizados, las indicaciones y las complicaciones descritas. De los artículos encontrados, se seleccionaron los más recientes y las Guías Europeas y Norteamericanas. El tratamiento endoscópico del reflujo, que se ha impuesto progresivamente como técnica de elección para el tratamiento primario del RVU asociado a pielonefritis o a infecciones, permite retrasar el recurso a la cirugía. Palabras clave: reflujo vesicoureteral, tratamiento endoscópico, infecciones, agente expansor. SUMMARY Introduction.Vesico-ureteral reflux (VUR) is defined as the retrograde flow of urine from the bladder to the upper urinary tract and is distinguished in primary and secondary. It is present in 25-70% of children who have a urinary tract infection (UTI) associated with pyelonephritis, the association between UTI and VUR predisposes children to have renal scarring with consequent alteration of the functionality until chronic renal failure. Material and methods. We realized a review of the literature on the endoscopic treatment of vesico-ureteral reflux analyzing the different techniques, materials used for endoscopic injection, indications and complications described in the literature. Results. Over 100 articles we found on the endoscopic treatment of reflux with indications, complications and outcomes in the short, medium and long term. Of these we selected the most recent and current European and American Guidelines. Conclusions INTRODUCCIÓNL a s i n f e c c i o n e s u r i n a r i a s representan un problema común en los niños, con una incidencia del 5% en las niñas, y del 1% al 2% en los varones. El reflujo vesicoureteral (RVU) se define como el flujo de orina retrógrado desde la vejiga hasta el tracto urinario superior; se distingue en secundario, cuando la etiología es muy clara (como obstrucción cervicouretral, vejiga neurógena, etc.) y primario, cuando no se puede identificar una causa que lo explique y s e p r e s u m e q u e l a a n o m a l í a obedece a un defecto anatómico de la unión ureterovesical. Este reflujo está presente en el 25% al 70% de los niños que tienen una infección urinaria asociada a pielonefritis y está demostrado que la asociación entre RVU e infección urinaria los predispone a tener cicatrices renales, c o n l a c o n s e c u e n t e a l t e r a c i ó n de la función, que puede llegar progresivamente a cuadros de daño renal crónico. La presencia de RVU les permite a las bacterias que están en la vejiga alcanzar la vía urinaria superior y el riñón, con la posibilidad de producir pielonefritis y nefropatía de reflujo. Las cicatrices pueden aparecer después de un solo episodio de pielonefritis, especialmente en los niños pequeños. 1En l...

show abstract

Section: Reflejo Vesicoureteral Tratamiento Endoscópico / 351unclassified

Reflujo vesicoureteral. Tratamiento endoscópico

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Different kinds of injection materials including polytetrafluoroethylene (Teflon), silicone, cross-linked bovine collagen and dextranomers in sodium hyaluronan (DiHA) have been used for injection with various success rates [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. The long-term tissue effects of these materials are still obscure due to lack of clinical and experimental data in spite of wide spectrum usage for vesicoureteral reflux and incontinence.…”

Section: Introductionmentioning

confidence: 99%

Histological response to injected dextranomer-based implant in a rat model

et al. 2006

View full text Add to dashboard Cite

To investigate the short and long term histopathological alterations caused by submucosal injection of dextranomers in sodium hyaluronan (DiHA) based on an experimental rat model. Sixty Sprague-Dawley rats were assigned into two groups as group I and II, each containing 30 rats. Totally 0.1 ml of saline solution and 0.1 ml of DiHA were injected into the submucosa of bladder of first (control) and second groups, respectively. Both group I and II were further subdivided into three other groups as Group IA, IB, IC and Group IIA, IIB, IIC according to the sacrificial period. Group IA and IIA, IB and IIB, IC and IIC rats (ten rats for each group) were sacrificed 3, 6, and 12 months after surgical procedure, respectively. Two slides prepared from injection site of the bladder were evaluated completely for each rat by being unaware of the groups and at random by two independent senior pathologists to determine the fibroblast invasion, collagen formation, capillary growth and inflammatory reaction. Additionally, randomized brain sections from each rat were also examined to detect migration of the injection material. The measurements were made using an ocular micrometer at 10x magnification. The results were assessed using t-tests for paired and independent samples, with P<0.05 considered to indicate significant differences; all values were presented as the mean (SD). Migration to the brain was not detected in any group. Significant histopathological changes in the DiHA injected groups were granuloma formation in 43.3%, foreign body type giant cells in 76.6%, inflammatory infiltration in 100%, and fibroblasts surrounding microspheres in 100% of the rat bladder. The interaction between granuloma formation and long-term tissue effects in children is still obscure. We emphasize that further prospective human (and/or animal) studies are required to clarify the long-term effects of granuloma formation with regard to clinical applications.

show abstract

“…The literature consists of many papers which support our approach for the treatment of grade V VUR [6,9,12] . On the other hand, Chertin et al [13] have reported successful results of the ESI procedure for grade V VUR. They emphasized that there was no difference between patients with grade V and grade IV VUR with regard to success rates.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Treatment of Vesicoureteral Reflux in Children: Our Experience and Analysis of Factors Affecting Success Rate

Alkan¹,

Çiftçi²,

Şenocak³

et al. 2008

Urol Int

View full text Add to dashboard Cite

Aim: To clarify the factors affecting the success rate of endoscopic subureteral injection (ESI) treatment of vesicoureteral reflux (VUR). Method: All patients who had ESI treatment for VUR at our unit between 1999 and 2002 were retrospectively reviewed with regard to age, gender, causes of VUR, reflux grade, type of injected materials, number of injections, results of cystourethrograms (VCUG), and outcome. The injected implants were gluteraldehyde cross-linked bovine collagen (GclBC), dextranomers in sodium hyaluronan (DiSH) and calcium hydroxylapatite (CH). A successful result was defined as absence of VUR confirmed by VCUG performed 3 months after the ESI procedure. Basic descriptive statistics were performed along with the χ² test (p < 0.05 was significant). Results: 50 children (81 ureters) consisting of 27 girls (43 ureters) and 23 boys (38 ureters) with a mean age of 7.4 ± 4.6 years constituted the study group. Grade III VUR was the most prominent grade (42%, 34 ureters) noted in all age groups. There was no significant difference between boys and girls with regard to the number of each grade of VUR. The success rate of first ESI procedure was 55.6% and was similar in each grade of VUR varying from 50 to 66%. Repeated injections have resulted in an overall success rate of 84%. No significant difference was noted between the age groups with regard to the success rate of ESI. Repeated ESI procedures were found to be unsuccessful in grade V VUR when compared to other grades (p < 0.05).There was a significant difference between primary reflux (76.5%, 62 ureters) and exstrophic (21%, 17 ureters) patients with regard to the grade of VUR and success rate of ESI. Exstrophic patients presented with a higher incidence of grade V VUR (41%) and with a lower success rate of ESI (64.7%). DiSH was the most commonly used agent (47 ureters) followed by CH (22 ureters) and GclBC (12 ureters). The success rates of the ESI procedure by each material were 91.5, 81.8, and 58.3%, respectively. No significant difference was noted between DiSH and CH. Low success rates by GclBCwere attributed to less usage of the material. 82% of the ESI procedures were done by surgeon A (49 ureters) and B (18 ureters) with a success rate of 96 and 72%, respectively. No significant difference was noted between A and B with regard to the success rate and type of injected material and the success rate in each grade of VUR (p > 0.05). No untoward effects were noted in short- and long-term follow-up (mean 4 ± 1.2 years) of any patient. Conclusion: The ESI procedure provides a high success rate for the treatment of VUR which decreases in grade V VUR and presence of exstrophia vesica. Single injection of various materials has been found to be successful in most of the patients with grade II VUR, whereas grade IV and III patients have required repeated injections which have resulted in 100 and 94% success rates, respectively. Grade I VUR can be managed by close follow-up and appropriate antibiotic therapy without any surgical and/or endoscopic...

show abstract

Endoscopic Treatment of Primary Grades IV and V Vesicoureteral Reflux in Children With Subureteral Injection of Polytetrafluoroethylene

Abstract: STING is a simple, safe and effective outpatient procedure for grades IV and V vesicoureteral reflux.

Cited by 47 publications

References 17 publications

Reflujo vesicoureteral. Tratamiento endoscópico

Reflujo vesicoureteral. Tratamiento endoscópico

Histological response to injected dextranomer-based implant in a rat model

Endoscopic Treatment of Vesicoureteral Reflux in Children: Our Experience and Analysis of Factors Affecting Success Rate

Contact Info

Product

Resources

About