Retrospective Study of Endoscopic Treatment in Children with Primary Vesicoureteral Reflux and Multivariate Analysis of Factors for Failure - Beyond the Abstract
European and American guidelines on VUR treatment do not answer reasons for failure in endoscopic VUR treatment, and while endoscopic treatment options continue to be developed, recurrence after endoscopic surgery continues to be an issue. To overcome this issue, we aimed to investigate reasons for recurrence of VUR after subureteral injection (STING) in our series.
The surgical procedure includes a hydrodistention test and intraureteral injection technique under general anesthesia. In the present series, the first NA Dx/HA injection was successful in 133 (77.3%) children (in 223 ureters or 79.6%). After re-injection, the endoscopic VUR treatments were successful in 157 (91.2%) children (in 253 ureters or 90.4%). All patients underwent voiding cystourethrography (VCUG) before and in follow-up at the third and sixth month after injection. According to multivariant logistic regression analyses, postoperative febrile urinary tract infection (fUTI) and/or renal scarring are the only factors which are correlated with failed endoscopic correction of VUR. Additionally, the present series pointed to an interesting issue as there was only one postoperative fUTI in a grade II VUR child. The success rate in grade II VUR was 85.2% in the first injection. After re-injection, the overall success rate was 100%, and there was no fUTI in any grade II VUR child. Additionally, the success rate was 100% after the first injection in grade I children. Thus, in light of our results, if the patient with grade I and grade II VUR had no renal scarring before injection (and without fUTI in postoperative period) it may not be necessary to perform VCUG, which is an x-ray based, traumatic examination.
The retrospective nature, low number of patients, and lack of follow-up data were considered as limitations of the study. While STING by using small microspheres (80-120 micron) of NA Dx/HA is a safe procedure as an endoscopic treatment option of VUR in children, there is no doubt that further randomized, prospective, multicenter studies are required to confirm the optimal management of VUR and the appropriate follow-up period.
Written by: Yigit Akin, MD Assistant Professor of Urology, Department of Urology, Harran University School of Medicine 63100, Sanliurfa, Turkey
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