Endoscopic treatment of symptomatic refluxing renal transplant ureteroneocystostomies in children

Abstract

To present a multi-center experience with the use of Dx/HA copolymer for treatment of symptomatic refluxing renal transplant UNC in children. A multi-center, retrospective chart review was performed. Eleven patients with a mean age of eight yr underwent renal transplantation with an anti-refluxing UNC. Data were collected to determine the safety and effectiveness of the procedure and to identify possible predictors of success. Endoscopic treatment was successful in one of five males and five of six females, for an overall success rate of 54.5%. The etiology of renal failure was associated with success of treatment, with 4/6 (67%) patients with upper tract pathology demonstrating resolution of the VUR, as compared with one of three (33%) patients with lower tract pathology. Male patients had a higher incidence of lower tract pathology. No complications were associated with the endoscopic procedure. Endoscopic injection of Dx/HA remains a safe option for the treatment of symptomatic refluxing transplant UNC in children. Although the success rate is lower than that seen in the treatment of primary VUR, the minimally invasive nature and safety of this technique may offer advantages over open reconstruction of the refluxing transplant ureter.

When does vesicoureteral reflux in pediatric kidney transplant patients need treatment?

“…While Dx/HA subureteric injection has minimal immediate morbidity, it is less successful in pediatric transplant ureters than in native ureters, has a significant delayed morbidity of ureteral obstruction, and decreases the success rate of subsequent ureteral reimplantation. The total published experience of Dx/HA injection in 20 pediatric patients shows a success rate of 50% . This is understandable due to the shorter submucosal tunnel and the need to inject a large amount of Dx/HA circumferentially around the ureteral orifice to resolve the VUR.…”

Endoscopic antireflux surgery leading to obstruction in pediatric renal transplant patients

“…The authors note that mean UTI rate was 4.4 per patient prior to the study, and at follow‐up of 17.3 months, no patients had recurrent UTI. Another multi‐institutional study reviewed 11 patients and had success in 54.5% of patients with a history of febrile or symptomatic UTI. Outcome data on any further UTIs were not reported.…”

“…VUR after renal transplantation in pediatric patients has been reported as high as 58% and is associated with recurrent UTI, acute and chronic renal insufficiency, and loss of graft function . The role of Dx/HA (Deflux ® , Salix Pharmaceuticals, a subsidiary of Valeant Pharmaceuticals International, Rochester, NY, USA) in treating VUR in transplant kidneys has been described with varying degrees of success in both the adult and pediatric populations. There have been few reported cases of ureteral obstruction after Dx/HA injection in a renal transplant in both the adult and pediatric population.…”

CKD and Bladder Problems in Children

“…If recurrent pyelonephritis occurs, cystoscopic (endoscopic) injection therapy with dextranomer/hyaluronic acid (Deflux, QMed Scandinavia) is recommended, although the success rate for transplanted ureters is only 55%, as it is often difficult to access the transplant ureteral orifice endoscopically. 48 In contrast, the success rate with standard ureteral reimplantation with a native kidney is 98%. 49 Alternatively, transplant ureteral reimplantation with an extravesical technique (open surgical) can be used, which has a success rate of 85%.…”