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

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.

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

10.21203/rs.3.rs-199231/v1 ◽

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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Positional installation of contrast cystography: A new approach in the diagnosis of vesicoureteral reflux

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0812617p ◽

2008 ◽

Vol 136 (11-12) ◽

pp. 617-620

Author(s):

Milan Paunovic ◽

Polina Pavicevic ◽

Vladimir Radlovic ◽

Vojkan Vukadinovic

Keyword(s):

Contrast Medium ◽

Vesicoureteral Reflux ◽

Diagnostic Procedures ◽

Voiding Cystourethrography ◽

Ureteral Orifice ◽

Endoscopic Appearance ◽

New Approach ◽

Normal Finding ◽

Normal Limits ◽

Grade Ii

INTRODUCTION Positional installation of contrast cystography (PIC cystography) represents a new method to identify vesicoureteral reflux (VUR) that is unrevealed by standard diagnostic procedures. It is performed by radiological examination of the vesicoureteral junction during cystoscopic installation of the contrast medium at the ureteral orifice. OBJECTIVE We studied the significance of PIC cystography to demonstrate VUR that failed to be revealed by standard voiding cystourethrography (MCUG), as well as the degree of the correlation of such a finding with endoscopic appearance and the position of the ureteral orifice (UO). METHOD The aim of the paper was to analyze a sample of 5 children (4 girls and 1 boy), aged 6-15 years (mean 9.8 years) with recurrent febrile urotract infections, complicated with scarring changes of the renal parenchyma and normal findings on MCUG. The grade of VUR demonstrated by PIC cystography was classified using the standard hydrodistensional scale. RESULTS All 5 patients had VUR, disclosed by PIC cystography, of whom in 4 it was unilateral and in one bilateral. Of 5 patients, 4 had VUR grade I and one grade II. All the children with VUR detected by PIC cystography also had evident cystoscopic abnormalities in the position and/or configuration of the ureteral orifice at the same side, while at the side with normal finding on PIC cystography, the endoscopic finding was also within normal limits. CONCLUSION PIC cystography is the method of choice in the confirmation of VUR as the cause of recurrent urotract infection and its complications in children with a normal finding on standard MCUG. In all our patients with VUR verified by PIC cystography, at the same side we also revealed endoscopic changes in the position and/or configuration of UO.

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Endoscopic Correction of Vesicoureteral Reflux

10.2310/uro.11028 ◽

2018 ◽

Author(s):

Michael Garcia-Roig ◽

Andrew J. Kirsch

Keyword(s):

Minimally Invasive ◽

Antibiotic Prophylaxis ◽

Vesicoureteral Reflux ◽

Implantation Technique ◽

Voiding Cystourethrogram ◽

Successful Result ◽

Endoscopic Injection ◽

Invasive Method ◽

Endoscopic Correction ◽

Parent Preference

Management of vesicoureteral reflux may involve a period of observation while the patient is on continuous antibiotic prophylaxis while awaiting spontaneous resolution. There are several indications for surgical correction that include non-resolution after a period of observation, parent preference, or breakthrough infections while on antibiotic prophylaxis, just to name a few. Endoscopic injection for correction of vesicoureteral reflux is an effective, minimally invasive method of treatment. Successful treatment is dependent on surgical technique, with a success rate of 77 to 94% with the double hydrodistension implantation technique (HIT) and uniform endpoints of injection. We aim to describe the double HIT technique for endoscopic injection along with tips and tricks for a successful result. This review contains 10 figures, 5 tables and 26 references Keywords: Vesicoureteral reflux, minimally invasive, febile urinary tract infection, voiding cystourethrogram, deflux, dextranomer/hyaluronic acid, children, cystoscopy, pyelonephritis, endoscopy

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Long-Term follow-up of Trigonoplasty Antireflux Operation

Urologia Journal ◽

10.5301/uro.5000212 ◽

2016 ◽

Vol 84 (1) ◽

pp. 48-50 ◽

Cited By ~ 1

Author(s):

Farzaneh Sharifiaghdas ◽

Nastaran Mahmoudnejad ◽

Amir H. Kashi ◽

Mehdi H. Ramezani ◽

Behzad Narouie

Keyword(s):

Urine Analysis ◽

Voiding Cystourethrography ◽

Ureteral Orifice ◽

Abdominal Sonography ◽

Antireflux Operation ◽

Long Term Follow Up ◽

Direct Radionuclide Cystography ◽

History Of

Background Open trigonoplasty antireflux operation has been associated with promising results. However, its success in controlling reflux has not been evaluated in the long term. Methods All patients who underwent trigonoplasty for vesicoureteral reflux by one surgeon from 2004 to 2014 were included. Pre-Operative evaluations included direct radionuclide cystography (DRNC) or voiding cystourethrography, urine analysis and culture and abdominal sonography. Urodynamic study and cystoscopy was performed in selected patients. Trigonoplasty was done by a modified Gil-Verent method. The latest available patients’ DRNCs were used to judge for reflux relapse. Results Ninety-one patients, 142 refluxing units; median (range) age, 10.5 (1-45) years; M/F, (11/80) were followed for 18 to 135 months. Reflux resolution rate was 73.6% for patients and 75.4% for refluxing units. Relapse was associated with reflux grade (67% in grade V), ureteral orifice appearance (40% in golf hole/stadium), and patients with a history of pyelonephritis. Multivariable model based on the above variables had less than 10% sensitivity in predicting relapse. Conclusions Trigonoplasty success rate can decrease with long-term follow-up.

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

Canadian Urological Association Journal ◽

10.5489/cuaj.3610 ◽

2016 ◽

Vol 10 (5-6) ◽

pp. 210 ◽

Cited By ~ 5

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.

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Vesicoureteral Reflux and Urinary Tract Infection in Children With a History of Prenatal Hydronephrosis—Should Voiding Cystourethrography be Performed in Cases of Postnatally Persistent Grade II Hydronephrosis?

The Journal of Urology ◽

10.1016/j.juro.2008.10.057 ◽

2009 ◽

Vol 181 (2) ◽

pp. 801-807 ◽

Cited By ~ 51

Author(s):

Carlos R. Estrada ◽

Craig A. Peters ◽

Alan B. Retik ◽

Hiep T. Nguyen

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Vesicoureteral Reflux ◽

Voiding Cystourethrography ◽

History Of ◽

Grade Ii ◽

Prenatal Hydronephrosis

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Endoscopic Treatment of Vesicoureteral Reflux with Dextranomer/Hyaluronic Acid in Children

Advances in Urology ◽

10.1155/2008/513854 ◽

2008 ◽

Vol 2008 ◽

pp. 1-7 ◽

Cited By ~ 13

Author(s):

Wolfgang H. Cerwinka ◽

Hal C. Scherz ◽

Andrew J. Kirsch

Keyword(s):

Hyaluronic Acid ◽

Vesicoureteral Reflux ◽

Endoscopic Treatment ◽

Outcome Data ◽

Implantation Technique ◽

Success Rates ◽

Endoscopic Injection ◽

Acid Copolymer ◽

Endoscopic Method ◽

First Choice

Purpose. The goal of this review is to present current indications, injectable agents, techniques, success rates, complications, and potential future applications of endoscopic treatment for vesicoureteral reflux (VUR) in children.Materials and Methods. The endoscopic method currently achieving one of the highest success rates is the double hydrodistention-implantation technique (HIT). This method employs dextranomer/hyaluronic acid copolymer, which has been used in pediatric urology for over 10 years and may be at present the first choice injectable agent due to its safety and efficacy.Results. While most contemporary series report cure rates of greater than 85% for primary VUR, success rates of complicated cases of VUR may be, depending on the case, significantly lower. Endoscopic treatment offers major advantages to patients while avoiding potentially complicated open surgery. As the HIT method continues to be applied to complex cases of VUR and more outcome data become available, the indication for endoscopic treatment may exceed the scope of primary VUR.Conclusions. Endoscopic injection is emerging as the treatment of choice for VUR in children.

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Results of use of polyacrylamide gel Noltrexsin in patients with different grades of gonarthrosis in outpatient practice

Medical alphabet ◽

10.33667/2078-5631-2021-33-20-29 ◽

2021 ◽

pp. 20-29

Author(s):

V. I. Kuznetsov

Keyword(s):

Synovial Fluid ◽

Local Injection ◽

Injection Therapy ◽

Joint Disease ◽

Osteoarthritis Of The Knee ◽

Lequesne Index ◽

Priority Method ◽

Grade 3 ◽

Outpatient Practice ◽

Grade Iii

Introduction. Osteoarthritis of the knee joints is the most common joint disease affecting more than 80% of people over 55 years of age. The priority method for the treatment of gonarthrosis is the use of local injection therapy with the introduction of synovial ﬂuid endoprostheses based on hyaluronic acid, included in the Second Step of the ESCEO 2019 algorithm. Viscoelastic polyacrylamide gels for intra-articular administration since 2003 have also shown their high effciency in the symptomatic OA treatment. Since 2018, the new 3rd generation PAAG endoprosthesis of synovial ﬂuid, Noltrexsin, has been actively used.Objective. To compare the efficacy and safety of Noltrexsin viscoprosthesis use with oral NSAIDs in patients with grade I-III of gonarthrosis.Materials and methods. 40 patients with gonarthrosis participated in a comparative study of the effcacy and safety of injection therapy Noltrexsin 4.0 ml No. 2 (study group, А) and oral administration of NSAIDs 200 mg per day (comparison group, В). NSAIDs were taken in groups A and B, the duration of therapy in both groups was 1 month. The results were evaluated by standard examination methods, including measuring the range of motion in the joint and scoring of physical signs, tests with walking up the stairs and at a distance, VAS, WOMAC, Lequesne Index.Results. In group А, a more signifcant reduction in pain according to VAS was revealed to 15–20 mm at the grade I–II of gonarthrosis and up to 25–30 mm in the grade III, a decrease in the Lequesne index to 1–2 and 3–4 points, respectively. In group В with a standard therapy, and then on-demand within 6 months, a decrease in VAS was revealed on the 8–9th day, and after 6 months the level of pain at the grade I–II did not exceed 20–25 mm, at the grade 3 it did not decrease below 40–45 mm. The Lequesne Index decreased to 2 points at the grade I–II and to 6–7 points at the grade III. Changes of WOMAC index correlated with VAS.Conclusions. 1. Noltrexsin can be used as a safe endoprosthesis of synovial ﬂuid in the form of local injection therapy in patients with insufficient effect of chondroprotectors and NSAIDs. 2. Noltrexsin is recommended for use at all stages of arthrosis, as well as in comorbid patients.

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