ENDOSCOPIC CORRECTION OF THE VESICOURETERAL REFLUX AFTER URETERAL REIMPLANTATION IN CHILDREN



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Abstract

Introduction. Vesicoureteral reflux (VUR) is seen in 2 - 60% of patients after ureteral reimplantation. The present study summarizes the experience of several centers where endoscopic correction of the postoperative reflux was done with bulking preparations. Material and methods. A retrospective study including 43 patients (24 boys and 19 girls) with reflux of grade III-IV after various transvesical and extravesical ureteral reimplantations for primary megaureter, reflux, or kidney transplantation was performed. Exclusion criteria were: neurogenic bladder, posterior urethral valve and ureterocele. Patients’ age varied from 9 months to 17 years (average 70.6 months). VUR was unilateral in 40 patients and bilateral in 3 patients: a total number of operated ureters was 46. The interval between ureter reimplantation and endoscopic surgery ranged from 3 months to 8 years (average 18.9 months). Different biodegradable and stable bulking preparations were used in the procedure. Results. VUR was successfully corrected in 19 ureters (41.3%) after a single injection. The repeated procedure was performed in 14 ureters in case of decreased reflux grade after the first injection. In 5 ureters (35.7%), the reflux resolved after the repeated procedure. With the two mentioned injections, the total effectiveness of endoscopic VUR correction was 52.2%. There were no any ureteral obstruction. The only statistically significant factor affecting the effectiveness of treatment was the reflux degree. The effectiveness level for reflux grade III was 68.2% and for reflux grade IV - 37.5%. Conclusion. Endoscopic correction prevents ureter reimplantation in half of patients with a high grade of postoperative vesicoureteral reflux.

About the authors

V. I. Dubrov

2nd City Children’s Clinical Hospital

Author for correspondence.
Email: dubroff2000@mail.ru
ORCID iD: 0000-0002-3705-1288
Россия

S. G. Bondarenko

Clinical Emergency Hospital No 7

Email: noemail@neicon.ru
ORCID iD: 0000-0001-5130-4782
Россия

I. M. Kagantzov

Republican Children’s Clinical Hospital; Pitirim Sorokin Syktyvkar State University

Email: noemail@neicon.ru
ORCID iD: 0000-0002-3957-1615
Россия

V. V. Sizonov

Regional Children’s Clinical Hospital; Rostov State Medical University

Email: noemail@neicon.ru
ORCID iD: 0000-0001-9145-8671
Россия

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