Is Endoscopic Injection Therapy a Reasonable Treatment Option for Low-grade Vesicoureteral Reflux in Association With Overactive Bladder?

Urology ◽  
2011 ◽  
Vol 78 (3) ◽  
pp. 675-678 ◽  
Author(s):  
Kate H. Kraft ◽  
Joseph A. Molitierno ◽  
Liisa Dewhurst ◽  
Christine Geers ◽  
Kristin Gunderson ◽  
...  
Keyword(s):  
Overactive Bladder ◽  
Vesicoureteral Reflux ◽  
Treatment Option ◽  
Injection Therapy ◽  
Low Grade ◽  
Endoscopic Injection

scholarly journals The role of voiding cystourethrography in the investigation of children with urinary tract infections

2016 ◽  
Vol 10 (5-6) ◽  
pp. 210 ◽  
Author(s):  
Linda C. Lee ◽  
Armando J. Lorenzo ◽  
Martin A. Koyle
Keyword(s):  
Urinary Tract ◽  
Vesicoureteral Reflux ◽  
Urinary Tract Infections ◽  
Renal Scarring ◽  
High Rate ◽  
Voiding Cystourethrography ◽  
Low Grade ◽  
Endoscopic Injection ◽  
Febrile Uti ◽  
Tract Infections

Urinary tract infections (UTIs) represent a common bacterial cause of febrile illness in children. Of children presenting with a febrile UTI, 25‒40% are found to have vesicoureteral reflux (VUR). Historically, the concern regarding VUR was that it could lead to recurrent pyelonephritis, renal scarring, hypertension, and chronic kidney disease. As a result, many children underwent invasive surgical procedures to correct VUR. We now know that many cases of VUR are low-grade and have a high rate of spontaneous resolution. The roles of surveillance, antibiotic prophylaxis, endoscopic injection, and ureteral reimplantation surgery also continue to evolve. In turn, these factors have influenced the investigation of febrile UTIs.Voiding cystourethrography (VCUG) is the radiographic test of choice to diagnose VUR. Due to its invasive nature and questionable benefit in many cases, the American Academy of Pediatrics (AAP) no longer recommends VCUG routinely after an initial febrile UTI. Nevertheless, these guidelines pre-date the landmark Randomized Intervention of Children with Vesicoureteral Reflux (RIVUR) trial and there continues to be controversy regarding the diagnosis and management of VUR. This paper discusses the current literature regarding radiographic testing in children with febrile UTIs and presents a practical risk-based approach for deciding when to obtain a VCUG.

scholarly journals Antireflux endoscopic injection therapy in post-pubertal patients via techniques adopted for the dilated ureteral orifice: a retrospective single-center study

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tetsuji Maruyama ◽  
Kentaro Mizuno ◽  
Hidenori Nishio ◽  
Taiki Kato ◽  
Takashi Hamakawa ◽  
...  
Keyword(s):  
Vesicoureteral Reflux ◽  
Injection Therapy ◽  
Voiding Cystourethrography ◽  
Implantation Technique ◽  
Ureteral Orifice ◽  
Endoscopic Injection ◽  
Implantation Techniques ◽  
History Of ◽  
Grade 3 ◽  
Grade Iii

Abstract Background To investigate the efficacy and safety of endoscopic injection therapy for vesicoureteral reflux in post-pubertal patients with dilated ureteral orifice via modified hydrodistension implantation techniques. Methods We retrospectively reviewed medical records including operational procedure and clinical course of all consecutive patients over 12 years old with a history of injection therapy. Endoscopic injection of dextranomer/hyaluronic acid copolymer was performed under hydrodistension implantation technique with some modifications in order to inject through dilated ureteral orifice align with the intramural ureter. Technical selections were done according to hydrodistension grade of the ureteral orifice. Voiding cystourethrography was evaluated at 3 months postoperatively. Hydronephrosis was evaluated using ultrasonography preoperatively until 6 months postoperatively. Results From 2016 to 2019, 12 patients (all female, 16 ureteral units; median age 32 [range 15–61] years) underwent endoscopic injection therapy at one of our institutions. We have identified grade II vesicoureteral reflux in 5 ureters, grade III in 8, and grade IV in 3 ureters. Grade 3 ureteral-orifice dilation were presented in 12 ureters (75%), grade 2 in 3 and grade 1 in 1 ureter in the present cases. Postoperatively, vesicoureteral reflux was diminished to grade 0 in 12 ureteral units (75%), decreased to grade I in 3 (9%), and remained grade III in 1 (6%). Three patients reported dull flank pain for several days postoperatively and there was 1 case of acute pyelonephritis. Temporary hydronephrosis was confirmed in 3 ureteral units (19%) at 1 month postoperatively. Median follow-up duration was 23 (range 13–63) months long. Although, 3 patients were experienced f-UTI 1–2 times, repeated VCUG showed no VUR recurrence. Conclusions According to hydrodistension grade of the ureteral orifice, endoscopic injection therapy via modified hydrodistension implantation technique is an effective and safe treatment for vesicoureteral reflux in post-pubertal female patients with dilated ureteral orifice. While ureteral deformities or a history of anti-reflux surgery may increase the risks, these can be managed with appropriate methods that ensure sufficient mound appearance and height.

Long-Term (>10 Years) Results After Endoscopic Injection Therapy for Vesicoureteral Reflux

2018 ◽  
Vol 28 (11) ◽  
pp. 1408-1411
Author(s):  
Luke Harper ◽  
Pierre Paillet ◽  
Thibault Minvielle ◽  
Eric Dobremez ◽  
Yan Lefevre ◽  
...  
Keyword(s):  
Vesicoureteral Reflux ◽  
Injection Therapy ◽  
Endoscopic Injection

Antireflux endoscopic injection therapy in adult patients via modified hydrodistention implantation techniques adopted for the dilated ureteral orifice: a retrospective single-center study

2021 ◽  
Author(s):  
Tetsuji Maruyama ◽  
Kentaro Mizuno ◽  
Hidenori Nishio ◽  
Taiki Kato ◽  
Takashi Hamakawa ◽  
...  
Keyword(s):  
Vesicoureteral Reflux ◽  
Adult Patients ◽  
Injection Therapy ◽  
Voiding Cystourethrography ◽  
Implantation Technique ◽  
Ureteral Orifice ◽  
Endoscopic Injection ◽  
Implantation Techniques ◽  
Grade 3 ◽  
Grade Iii

Abstract Background To investigate the efficacy and safety of endoscopic injection therapy for vesicoureteral reflux in adult patients with dilated ureteral orifice via modified hydrodistension implantation techniques. Methods We retrospectively reviewed medical records including operational procedure and clinical course of all consecutive patients over 12 years old with a history of injection therapy. Endoscopic injection of dextranomer /hyaluronic acid copolymer was performed under hydrodistension implantation technique with some modifications in order to inject through dilated ureteral orifice align with the intramural ureter. Technical selections were done according to hydrodistension grade of the ureteral orifice. Voiding cystourethrography was evaluated at 3 months postoperatively. Hydronephrosis was evaluated using ultrasonography preoperatively until 6 months postoperatively. Results From 2016 to 2019, 12 patients (all female, 16 ureteral units; median age 32 [range: 15 to 61] years) underwent endoscopic injection therapy at one of our institutions. We have identified grade II vesicoureteral reflux in 5 ureters, grade III in 8, and grade IV in 3 ureters. Grade 3 ureteral-orifice dilation were presented in 12 ureters (75%), grade 2 in 3 and grade 1 in ureter in the present cases. Postoperatively, vesicoureteral reflux was diminished to grade 0 in 12 ureteral units (75%), decreased to grade I in 3 (9%), and remained grade III in 1 (6%). Three patients reported dull flank pain for several days postoperatively and there was 1 case of acute pyelonephritis. Temporary hydronephrosis was confirmed in 3 ureteral units (19%) at 1 month postoperatively. Conclusions According to hydrodistension grade of the ureteral orifice, endoscopic injection therapy via modified hydrodistension implantation technique is an effective and safe treatment for vesicoureteral reflux in adult patients with dilated ureteral orifice.

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