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Vol. 81, No. 1, 2008
Issue release date: July 2008
Section title: Original Paper
Urol Int 2008;81:41–46
(DOI:10.1159/000137639)

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

Alkan M. · Ciftci A.O. · Senocak M.E. · Tanyel F.C. · Buyukpamukcu N.
Department of Pediatric Surgery, Hacettepe University Medical Faculty, Ankara, Turkey

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 8/14/2006
Accepted: 4/17/2007
Published online: 7/16/2008

Number of Print Pages: 6
Number of Figures: 0
Number of Tables: 5

ISSN: 0042-1138 (Print)
eISSN: 1423-0399 (Online)

For additional information: http://www.karger.com/UIN

Abstract

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 intervention. Patients presenting with grade V VUR should undergo open surgery if the first trial of ESI procedure results in failure as repeated injections have proved to be unsuccessful in this grade. The success rate of the ESI procedure does not seem to be affected by the type of injected material and different surgeons performing the procedure after achieving the learning curve.


  

Author Contacts

Murat Alkan, MD
Department of Pediatric Surgery, Cukurova University, Faculty of Medicine
TR–01330 Balkalı/Adana (Turkey)
Tel. +90 322 338 3106, Fax +90 322 338 7323
E-Mail drmuratalkan@hotmail.com or malkan@cu.edu.tr

  

Article Information

Received: August 14, 2006
Accepted after revision: April 17, 2007
Published online: July 16, 2008
Number of Print Pages : 6
Number of Figures : 0, Number of Tables : 5, Number of References : 19

  

Publication Details

Urologia Internationalis

Vol. 81, No. 1, Year 2008 (Cover Date: July 2008)

Journal Editor: Wirth M.P. (Dresden), Porena M. (Perugia), Hakenberg O.W. (Rostock), Castro-Diaz D. (Santa Cruz de Tenerife)
ISSN: 0042–1138 (Print), eISSN: 1423–0399 (Online)

For additional information: http://www.karger.com/UIN


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 8/14/2006
Accepted: 4/17/2007
Published online: 7/16/2008

Number of Print Pages: 6
Number of Figures: 0
Number of Tables: 5

ISSN: 0042-1138 (Print)
eISSN: 1423-0399 (Online)

For additional information: http://www.karger.com/UIN


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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