Single Center Experience With Endoscopic Management of Vesicoureteral Reflux in Children

Routh, Jonathan C.; Vandersteen, David R.; Pfefferle, Heidi; Wolpert, James J.; Reinberg, Yuri

doi:10.1016/s0022-5347(05)00926-2

Cited by 56 publications

(24 citation statements)

References 12 publications

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“…Our cure rates achieved with Dx/HA injection therapy were correlated inversely with VUR grade and the cure rate was significantly lower in patients with grade V. While similar findings have been reported in many studies [11,15,16], this relation was not observed in some other studies [9,13]. Lavella et al reported that mound morphology, but not other factors including grade, volume injected, endoscopic appearance after injection and presence or voiding dysfunction, was the only statistically significant predictor of a successful outcome [17].…”

Section: Discussionsupporting

confidence: 89%

“…In literature, a wide range of variable success rates were reported for patients with duplicated system, perhaps due to differences in the patients' characteristics, techniques, experience with surgery and the materials used. While some of the authors reported that the success rate was significantly lower for duplicated versus single system as in the present study [9,11,16], others reported that a duplex system did not attain significance [18][19][20]. In our study, caudal migration of the Dx/HA implant was the most common findings in repeated cystoscopy for patients with initial treatment failure.…”

Section: Discussioncontrasting

confidence: 52%

“…Cystitis occurs in 6.4% of patients, bladder spasms in 2% and febrile urinary tract infection in 0.75% of patients [11,12]. Ureteral obstruction rarely occurs [16,22]. In our study, there was not any serious adverse event and only minor complications were seen in 2.9% of the patients.…”

Section: Discussionsupporting

confidence: 42%

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Are there predictive factors for the outcome of endoscopic treatment of grade III–V vesicoureteral reflux with dextranomer/hyaluronic acid in children?

et al. 2007

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Dextranomer/hyaluronic acid (Dx/HA) copolymer has been used widely for the treatment of vesicoureteral reflux (VUR) in children since 2001. However, the factors that influence the outcome of injection therapy with Dx/HA have remained unclear. In this study, we retrospectively evaluated the outcomes in 101 consecutive children to determine the cure and to identify the factors that can impact treatment outcomes of Dx/HA injection. Endoscopic treatment with Dx/HA was performed in 133 ureters, in 101 patients with grade III-V VUR. Of the patients, 68 (67.3%) were girls and the mean age was 6.5 years. Before and after the treatment, the presence and grades of VUR were determined by voiding cystourethrograms. The patients' age, gender, laterality, preoperative reflux grade, ureteral duplication, morphology of ureteral orifice, renal hypoplasia and experience with surgery were assessed as predictive factors related to the success rates of Dx/HA injection therapy. The cure rates were 54.8% after the first injection, 66.9% after the second and 73.6% after the third injection. Patients with a high grade (grade IV or V), duplicated system, golf hole-shaped orifice and renal hypoplasia had significantly lower cure rates (P<0.05). Experience with the technique also correlated with the positive outcome of the procedure. New contralateral vesicoureteral reflux developed in five (7.2%) patients with unilateral VUR, and all of them resolved spontaneously during the first year of followup. No treatment-related significant complication was encountered. Although, endoscopic treatment of VUR with Dx/HA provides a high rate of success in children with medium or high grade VUR, treatment failure may be seen in some patients. However, we showed that endoscopic treatment with Dx/HA was effective in selected patients with grade V VUR, and we emphasize the need for further large-scale studies to confirm our findings.

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Section: Discussionsupporting

confidence: 89%

Section: Discussioncontrasting

confidence: 52%

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Are there predictive factors for the outcome of endoscopic treatment of grade III–V vesicoureteral reflux with dextranomer/hyaluronic acid in children?

et al. 2007

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“…La tasa de éxito, aportada por diferentes grupos, va del 68% al 92% y depende principalmente del grado del reflujo inicial. [3][4][5]8 En el caso de persistencia de RVU después de la primera inyección, se puede intentar una segunda inyección con una tasa de éxito del 50% al 60%, y del 30% si hay una tercera inyección. 9 Actualmente, la Administración Estadounidense de Alimentos y Drogas (FDA) ha aprobado estos procedimientos en pacientes con grado de reflujo II-III y IV, mientras no hay suficiente evidencia científica para la utilización en pacientes con RVU de grado V. Según las Guías de la Asociación Europea de Urología (ESPU-EAU), las indicaciones para el tratamiento endoscópico de los pacientes con RVU son similares a las indicaciones para el tratamiento con cirugía abierta.…”

Section: Comentariounclassified

Reflujo vesicoureteral. Tratamiento endoscópico

et al. 2013

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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...

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“…Alternatively, surgery carries anesthetic and surgical risk. Complications include ureteric obstruction from either subureteric injection or ureteric reimplantation, resulting in invasive testing, surgeries, or renal failure [18,19]. However, the persistent impact on QOL is difficult to determine.…”

Section: Introductionmentioning

confidence: 99%

Quality of life in children with vesicoureteral reflux

et al. 2011

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Vesicoureteral reflux (VUR) is commonly diagnosed in children presenting with urinary tract infections. Antibiotic prophylaxis and ureteric surgery are standard treatments for these children. Our aim was to investigate whether health-related quality of life (HRQOL) was altered in children treated for VUR. Children aged 1-5 years with grade III or higher VUR were identified through electronic records at the Stollery Children's Hospital. Parents of these children were mailed the TNO-AZL Netherlands Organisation for Applied Scientific Research Academic Medical Centre Quality of Life (TAPQOL) questionnaire. QOL scores for this group were compared with normative controls from the instrument's creators using the Mann-Whitney U test. Thirty-two of the 96 (33%) mailed surveys were returned. Eight children had surgery, and 19 were treated with antibiotic prophylaxis. When comparing the VUR group with the control group, we found that anxiety and social functioning scores were significantly better in patients with VUR (p < 0.01). The VUR group had worse scores in problem behavior, stomach complaints ,and communication (p < 0.01). This study reveals that children with VUR have a reasonable QOL when compared with controls. However, the diagnosis of VUR and its management does have an impact on gastrointestinal complaints, behavior, and communication, which may occur as a result of chronic medical intervention.

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Single Center Experience With Endoscopic Management of Vesicoureteral Reflux in Children

Cited by 56 publications

References 12 publications

Are there predictive factors for the outcome of endoscopic treatment of grade III–V vesicoureteral reflux with dextranomer/hyaluronic acid in children?

Are there predictive factors for the outcome of endoscopic treatment of grade III–V vesicoureteral reflux with dextranomer/hyaluronic acid in children?

Reflujo vesicoureteral. Tratamiento endoscópico

Quality of life in children with vesicoureteral reflux

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