Intraoperative cystography pre- and post-endoscopic treatment for vesicoureteral reflux: Guaranteed success?

López, Pedro-José; Reed, Francisco; Ovalle, Alfredo; Celis, Sergio; Reyes, Dahna; Letelier, Nelly; Zubieta, Ricardo

doi:10.1016/j.jpurol.2014.02.002

Cited by 7 publications

(8 citation statements)

References 9 publications

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“…In this study, up to 60% of the 23 patients with VUR at preoperative tests 6 months before treatment had no VUR at the pre-treatment SVCU carried out under anesthesia. Consequently, the authors conclude that post-treatment SVCU is not useful to assess treatment results because of its low reliability under profound sedation (19) .…”

Section: Discussionmentioning

confidence: 97%

Usefulness of intraoperative voiding cystourethrogram as an indicator of sucess in the endoscopic treatment of vesicoureteral reflux

et al. 2022

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Objective. Up until now, serial voiding cystourethrogram (SVCU) has been regarded as the gold standard technique in the diagnosis of vesicoureteral reflux (VUR). The aim of intraoperative SVCU during endoscopic treatment is to detect those patients eligible to receive more biosynthetic material as a result of persistent VUR. The objective of this study was to assess the usefulness of SVCU as a predictor of treatment success.Materials and methods. An analytical, retrospective study of patient medical records was carried out. Patients included had undergone endoscopic VUR surgery from 2000 to 2019, and they were measured in ureteral units. VUR persistence at intraoperative SVCU following treatment was compared with SVCU results after 3 months.Results. Of a total of 167 ureteral units undergoing surgery, persistent reflux immediately after surgery was observed in 17 cases (10% of the sample). Only 3 cases had other urological malformations. In the SVCU carried out after 3 months, reflux was found in 38% of the sample (64 cases). When comparing the results, intraoperative SVCU demonstrated a specificity of 92.6%, and a sensitivity of 15.6%.Conclusions. Given the low sensitivity (15.6%) of intraoperative SVCU to detect cases of persistent reflux in the mid-term, and considering the risks associated with radiation in the pediatric population -which is extremely sensitive to it -, intraoperative SVCU should be ruled out as a useful indicator of endoscopic treatment success.

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Section: Discussionmentioning

confidence: 97%

Usefulness of intraoperative voiding cystourethrogram as an indicator of sucess in the endoscopic treatment of vesicoureteral reflux

et al. 2022

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“…This study showed the prevalence of occult VUR to be considerable postoperatively (6%). Although intraoperative cystography is not recommended for detection of occult VUR owing to its low sensitivity [24], other methods to predict occult VUR are needed. Alternatively, protective injection according to HD grade could be recommended [25], so that VUR grade is reported to have high correlation with HD grade [21] as mentioned in the former section.…”

Section: Discussionmentioning

confidence: 99%

Antireflux endoscopic injection therapy in adult patients via modified hydrodistention implantation techniques adopted for the dilated ureteral orifice: a retrospective single-center study

Maruyama¹,

Mizuno²,

Nishio³

et al. 2021

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Background To investigate the efficacy and safety of endoscopic injection therapy for vesicoureteral reflux in adult patients with dilated ureteral orifice via modified hydrodistension implantation techniques. Methods We retrospectively reviewed medical records including operational procedure and clinical course of all consecutive patients over 12 years old with a history of injection therapy. Endoscopic injection of dextranomer /hyaluronic acid copolymer was performed under hydrodistension implantation technique with some modifications in order to inject through dilated ureteral orifice align with the intramural ureter. Technical selections were done according to hydrodistension grade of the ureteral orifice. Voiding cystourethrography was evaluated at 3 months postoperatively. Hydronephrosis was evaluated using ultrasonography preoperatively until 6 months postoperatively. Results From 2016 to 2019, 12 patients (all female, 16 ureteral units; median age 32 [range: 15 to 61] years) underwent endoscopic injection therapy at one of our institutions. We have identified grade II vesicoureteral reflux in 5 ureters, grade III in 8, and grade IV in 3 ureters. Grade 3 ureteral-orifice dilation were presented in 12 ureters (75%), grade 2 in 3 and grade 1 in ureter in the present cases. Postoperatively, vesicoureteral reflux was diminished to grade 0 in 12 ureteral units (75%), decreased to grade I in 3 (9%), and remained grade III in 1 (6%). Three patients reported dull flank pain for several days postoperatively and there was 1 case of acute pyelonephritis. Temporary hydronephrosis was confirmed in 3 ureteral units (19%) at 1 month postoperatively. Conclusions According to hydrodistension grade of the ureteral orifice, endoscopic injection therapy via modified hydrodistension implantation technique is an effective and safe treatment for vesicoureteral reflux in adult patients with dilated ureteral orifice.

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Section: Discussionmentioning

confidence: 99%

Antireflux endoscopic injection therapy in post-pubertal patients via techniques adopted for the dilated ureteral orifice: a retrospective single-center study

et al. 2021

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Background To investigate the efficacy and safety of endoscopic injection therapy for vesicoureteral reflux in post-pubertal patients with dilated ureteral orifice via modified hydrodistension implantation techniques. Methods We retrospectively reviewed medical records including operational procedure and clinical course of all consecutive patients over 12 years old with a history of injection therapy. Endoscopic injection of dextranomer/hyaluronic acid copolymer was performed under hydrodistension implantation technique with some modifications in order to inject through dilated ureteral orifice align with the intramural ureter. Technical selections were done according to hydrodistension grade of the ureteral orifice. Voiding cystourethrography was evaluated at 3 months postoperatively. Hydronephrosis was evaluated using ultrasonography preoperatively until 6 months postoperatively. Results From 2016 to 2019, 12 patients (all female, 16 ureteral units; median age 32 [range 15–61] years) underwent endoscopic injection therapy at one of our institutions. We have identified grade II vesicoureteral reflux in 5 ureters, grade III in 8, and grade IV in 3 ureters. Grade 3 ureteral-orifice dilation were presented in 12 ureters (75%), grade 2 in 3 and grade 1 in 1 ureter in the present cases. Postoperatively, vesicoureteral reflux was diminished to grade 0 in 12 ureteral units (75%), decreased to grade I in 3 (9%), and remained grade III in 1 (6%). Three patients reported dull flank pain for several days postoperatively and there was 1 case of acute pyelonephritis. Temporary hydronephrosis was confirmed in 3 ureteral units (19%) at 1 month postoperatively. Median follow-up duration was 23 (range 13–63) months long. Although, 3 patients were experienced f-UTI 1–2 times, repeated VCUG showed no VUR recurrence. Conclusions According to hydrodistension grade of the ureteral orifice, endoscopic injection therapy via modified hydrodistension implantation technique is an effective and safe treatment for vesicoureteral reflux in post-pubertal female patients with dilated ureteral orifice. While ureteral deformities or a history of anti-reflux surgery may increase the risks, these can be managed with appropriate methods that ensure sufficient mound appearance and height.

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Intraoperative cystography pre- and post-endoscopic treatment for vesicoureteral reflux: Guaranteed success?

Cited by 7 publications

References 9 publications

Usefulness of intraoperative voiding cystourethrogram as an indicator of sucess in the endoscopic treatment of vesicoureteral reflux

Usefulness of intraoperative voiding cystourethrogram as an indicator of sucess in the endoscopic treatment of vesicoureteral reflux

Antireflux endoscopic injection therapy in adult patients via modified hydrodistention implantation techniques adopted for the dilated ureteral orifice: a retrospective single-center study

Antireflux endoscopic injection therapy in post-pubertal patients via techniques adopted for the dilated ureteral orifice: a retrospective single-center study

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