The Value of PIC Cystography in Detecting De Novo and Residual Vesicoureteral Reflux after Dextranomer/Hyaluronic Acid Copolymer Injection

Abstract

The endoscopic injection of Dx/HA in the management of vesicoureteral reflux (VUR) has become an accepted alternative to open surgery. In the current study we evaluated the value of cystography to detect de novo contralateral VUR in unilateral cases of VUR at the time of Dx/HA injection and correlated the findings of immediate post-Dx/HA injection cystography during the same anesthesia to 2-month postoperative VCUG to evaluate its ability to predict successful surgical outcomes. The current study aimed to evaluate whether an intraoperatively performed cystogram could replace postoperative studies. But a negative intraoperative cystogram correlates with the postoperative study in only 80%. Considering the 75–80% success rate of Dx/HA implantation, the addition of intraoperative cystograms cannot replace postoperative studies. In patients treated with unilateral VUR, PIC cystography can detect occult VUR and prevent postoperative contralateral new onset of VUR.

Clinical outcome after endoscopic therapy for occult vesicoureteral reflux in females: preliminary results of a retrospective case series

“…This was confirmed by a 2011 study, which demonstrated an 80% positive correlation between intraoperative negative PIC cystography and postoperative positive VCUG after endoscopic injection of Dx/HA [18].…”

Diagnostic value of hydrodistention of the ureteral orifice

“…Palmer et al [9] reported that 27 of the 34 patients, who were preoperatively diagnosed with unilateral VUR, intraoperatively demonstrated a positive PIC cystography in the contralateral ureters. The PIC-VUR correction was endoscopically performed without any complications and new postoperative contralateral VUR.…”

Utility of Positional Instillation of Contrast Cystography for Diagnosing Occult Vesicoureteral Reflux in Children: A Report of Two Cases

“…ing new contralateral VUR in cases of preoperatively unilateral VUR [7]. The major advantages of PIC cystography are the detection of occult VUR that cannot be detected by standard VCUG and the performance of simultaneous injection therapy to prevent VUR under the same anesthesia.…”