EFFICIENCY OF THE ENDOSOPIC CORRECTION OF HIGH-GRADE VESICOURETERAL REFLUX IN CHILDREN



Cite item

Full Text

Abstract

Introduction. The endoscopic correction of vesicoureteral reflux in children has become a basic treatment technique. Its effectiveness in the low-grade reflux is high. High-grade refluxes are an indication for antireflux reconstructive plastic surgery. The article analyzes outomes of endoscopic treatment of patients with high-grade retrograde urine reflux. Material and methods. A total number of 307 patients (409 ureters) with IV-V grade of vesicoureteral reflux were treated. 156 girls and 151 boys, aged 4 months - 12 years, had the endoscopic correction with Dextranomer and Copolymer of Polyacrylic Polyvinyl Alcohol (PPC). The renal parenchyma damage was assessed with DMSA scan; urinary tract infection - with clinical and laboratory findings (febrile temperature and bacteriuria). Outcomes of treatment were evaluated with micurating cystography performed six months later. It revealed either no reflux or its lower grade - grade one. Average follow-up period was 5. 5 years. Results. The effectiveness of endoscopic correction of vesicoureteral reflux after the first injection was 68.7%. The second injection was effective in 48.9%. Febrile urinary tract infection after the treatment went down up to 6.2%. Marked bacteriuria remained high - 55.3%. Renal parenchyma structural and functional damage was noted in 38.9% of older children; mild and moderate degrees of damage prevailed (45.6% and 40.8%, respectively). Conclusion. The endoscopic correction of high-grade vesicoureteral reflux is recommended as the first line treatment for retrograde urine reflux. This technique is highly effective and minimally invasive.

About the authors

S. N. Zorkin

National Medical Research Center for Children’s Health

Author for correspondence.
Email: zorkin@nczd.ru
Russian Federation

D. S. Shakhnovsky

National Medical Research Center for Children’s Health

Russian Federation

F. O. Turov

National Medical Research Center for Children’s Health

Russian Federation

A. T. Galuzinskaya

National Medical Research Center for Children’s Health

Russian Federation

E. Yu. Dyakonova

National Medical Research Center for Children’s Health

Russian Federation

References

  1. Williams G., Fletcher J.T., Alexander S.I. et al. Vesicoureteral reflux. J Am Soc Nephrol. 2008;19:847.
  2. Sargent M.A. What is the normal prevalence of vesicoureteral reflux? Pediatr Radiol. 2000; 30: 587.
  3. Swerkersson S., Jodal U., Sixt R. et al. Relationship among vesicoureteral reflux, urinary tract infection and renal damage in children. J Urol. 2007; 178:647.
  4. Peters C., Rushton H.G. Vesicoureteral reflux associated renal damage: congenital reflux nephropathy and acquired renal scarring. J Urol. 2010; 184: 265.
  5. Brandstrom P., Neveus T., Sixt R. et al. The Swedish reflux trial in children: IV. Renal damage. J Urol. 2010; 184:292.
  6. Routh J.C., Inman B.A., Reinberg Y. Dextranomer/hyaluronic acid for pediatric vesicoureteral reflux: systematic review. Pediatrics. 2010; 125:1010.
  7. Sjostrom S. Sillen U., Jodal U. et al. Predictive factors for resolution of congenital high grade vesicoureteral reflux in infants: results of univariate and multivariate analyses. J Urol. 2010; 183:1177.
  8. Traxel E., DeFoor W., Reddy P. et al. Risk factors for urinary tract infection after dextranomer/hyaluronic acid endoscopic injection. J Urol. 2009; 182:1708.
  9. Diamond D.A., Mattoo T.K. Endoscopic treatment of primary vesicoureteral reflux. N Engl J Med. 2012; 366: 1218.
  10. Capozza N., Lais A., Matarazzo E. et al. Treatment of vesico-ureteric reflux: a new algorithm based on parental preference. BJU Int. 2003; 92:285.
  11. Барсегян Е.Р., Зоркин С.Н. Сравнительная оценка результативности различных полимеров при эндоскопической коррекции пузырно-мочеточникового рефлюкса у детей. Детская хирургия. 2014; 5: 4-8.
  12. Хворостов И.Н., Смирнов И.Е., Кучеренко А.Г., Герасимова Н.П., Комарова О.В., Зоркин С.Н. Нефросцинтиграфия и цитокины в диагностике поражения почек при пузырно-мочеточниковом рефлюксе у детей. Российский педиатрический журнал. 2013; 2:20-6.
  13. Клиническая оценка расстройств мочеиспускания. Под ред. Е.Л. Вишневский, О.Б. Лоран, А.Е. Вишневский. М.: Терра, 2001.
  14. Kirsch A.J., Perez-Brayfield M.R., Scherz H.C. Minimally invasive treatment of vesicoureteral reflux with endoscopic injection of dextranomer/hyaluronic acid copolymer: the Children’s Hospitals of Atlanta experience. J Urol. 2003; 170:211
  15. Зоркин С.Н., Борисова С.А. Эндоскопическая коррекция пузырно-мочеточникового рефлюкса у детей. Лечащий Врач. 2013; 1: 42-4
  16. Ogan K., Pohl H.G., Carlson D. et al. Parental preferences in the management of vesicoureteral reflux. J Urol. 2001; 166:240.
  17. Hensle T.W., Grogg A.L., Eaddy M. Pediatric vesicoureteral reflux: treatment patterns and outcomes. Nat Clin Pract Urol. 2007; 4:462.
  18. Peters C.A., Skoog S.J., Arant B.S. Jr et al. Summary of the AUA Guideline on Management of Primary Vesicoureteral Reflux in Children. J Urol. 2010; 184: 1134.
  19. Elder J.S., Shah M.B., Batiste L.R. et al. Part 3: Endoscopic injection versus antibiotic prophylaxis in the reduction of urinary tract infections in patients with vesicoureteral reflux. Curr Med Res Opin. 2007; 23: 15.
  20. Chertin B., Natsheh A., Fridmans A. et al. Renal scarring and urinary tract infection after successful endoscopic correction of vesicoureteral reflux. J Urol. 2009; 182:1703.
  21. Hunziker M., Colhoun E., Puri P. Prevalence and predictors of renal functional abnormalities of high grade vesicoureteral reflux. J Urol. 2013; 190:1490.
  22. Cara-Fuentes G., Gupta N., Garin E.H. The RIVUR study: a review of its findings. Pediatr Nephrol. 2015; 30:703.
  23. Medical versus surgical treatment of primary vesicoureteral reflux: report of the International Reflux Study Committee. Pediatrics. 1981; 67:392.
  24. Schwab C.W. Jr, Wu H.Y., Selman H. et al. Spontaneous resolution of vesicoureteral reflux: a 15-year perspective. J Urol. 2002; 168:2594.
  25. Elder J.S., Diaz M., Caldamone A.A. et al. Endoscopic therapy for vesicoureteral reflux: a meta-analysis. I. Reflux resolution and urinary tract infection. J Urol. 2006; 175:716.
  26. Elder J.S., Peters C.A., Arant B.S. Jr. et al. Pediatric Vesicoureteral Reflux Guidelines Panel summary report on the management of primary vesicoureteral reflux in children. J Urol. 1997; 157:1846.
  27. Holmdahl G., Brandstrom P., Lackgren G. et al. The Swedish reflux trial in children: II. Vesicoureteral reflux outcome. J Urol. 2010; 184:280.
  28. Elmore J.M., Kirsch A.J., Heiss E.A. et al. Incidence of urinary tract infections in children after successful ureteral reimplantation versus endoscopic dextranomer/hyaluronic acid implantation. J Urol. 2008; 179:2364.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2020