PURPOSE: To evaluate the success of endoscopic treatment of symptomatic vesicoureteral reflux (VUR) after renal transplantation and to identify the predictive factors of success.
MATERIALS AND METHODS: Between January 2000 and December 2010, 58 patients (38 women, 20 men) were treated by endoscopy for symptomatic VUR after renal transplantation. VUR was documented by retrograde cystography and its symptomatic character was determined by at least one episode of acute graft pyelonephritis (AGPN). The results of endoscopic treatment were evaluated clinically at 1, 3 months and then annually, and radiologically (cystography) at 3 months. Clinical success was defined at the absence of AGPN during follow-up. Radiological success was defined as the absence of reflux on control cystography at 3 months.
RESULTS: Clinical success of endoscopic treatment was 56.1% (32 patients): 65% (26 patients) with Deflux® and 33.3% (5 patients) with Macroplastique®, and radiological success was 26.4% (14 patients) with a mean follow-up of 38 ± 33 months. In multivariate analysis, male gender and use of Deflux® were predictive factors for clinical success. Grade of reflux was not predictive for success or failure. No high-grade complication was reported.
CONCLUSIONS: Endoscopic treatment of symptomatic VUR of a transplanted kidney was effective in half of cases whatever the bulking agent used, but Deflux® appeared to be more effective than Macroplastique®. Due to its minimally invasive character and its low morbidity, endoscopic treatment with Deflux® could be proposed as first-line treatment before surgery for symptomatic VUR of a transplanted kidney whatever the grade of reflux.
Written by:
Akiki A, Boissier R, Delaporte V, Maurin C, Gaillet S, Karsenty G, Coulange C, Lechevallier E. Are you the author?
La Conception University Hospital.
Reference: J Urol. 2014 Jul 31. pii: S0022-5347(14)04141-X.
doi: 10.1016/j.juro.2014.07.103
PubMed Abstract
PMID: 25088951
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