Endoscopic Correction of Vesicoureteral Reflux

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 

scholarly journals Avoiding routine postoperative voiding cystourethrogram: Predicting radiologic success for endoscopically treated vesicoureteral reflux

2018 ◽  
Vol 13 (5) ◽  
Author(s):  
Peter (Zhan Tao) Wang ◽  
Ahmed Abdelhalim ◽  
Arman Walia ◽  
Elias Wehbi ◽  
Sumit Dave ◽  
...  
Keyword(s):  
Prediction Model ◽  
Vesicoureteral Reflux ◽  
Sensitivity And Specificity ◽  
Predictive Performance ◽  
Implantation Technique ◽  
Voiding Cystourethrogram ◽  
Success Rates ◽  
Acid Copolymer ◽  
Endoscopic Correction ◽  
Mound Morphology

Introduction: Variability in the success rates for the endoscopic correction of vesicoureteral reflux (VUR) has prompted a debate regarding the use of routine postoperative voiding cystourethrogram (VCUG). This study examines the predictive performance of intraoperative mound morphology (IMM) and the presence of a postoperative ultrasound mound (PUM) on radiologic success, as well as investigates the role of using these two predictive factors as a composite tool to predict VUR resolution after endoscopic treatment. Methods: This retrospective study included children with primary VUR who underwent endoscopic correction with a double hydrodistension-implantation technique (HIT) and dextranomer/ hyaluronic acid copolymer. IMM was assessed intraoperatively. The presence of a PUM and VUR resolution were assessed by postoperative ultrasound (US) and VCUG, respectively. Radiologic success was defined as VUR resolution. Results: A total of 70 children (97 ureters) were included in the study. The overall radiologic success rate was 83.5%. There was no statistically significant association between radiologic success and IMM (85.2% with excellent and 87.5% with “other” morphology; p=0.81). The sensitivity and specificity of PUM for radiologic success in this study was 98% and 71%, respectively, while the sensitivity and specificity of the combined prediction model were 81.9% and 85.7%, respectively. Conclusions: We objectively demonstrated that IMM was a poor predictor of radiologic success and should be used with caution. In addition, the performance of a combined prediction model was inferior to the presence of a PUM alone. As such, selective use of postoperative VCUG may be guided solely by the presence of a PUM.

scholarly journals Computer-Enhanced Visual Learning Method to Teach Endoscopic Correction of Vesicoureteral Reflux: An Invitation to Residency Training Programs to Utilize the CEVL Method

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Michael Bauschard ◽  
Max Maizels ◽  
Andrew Kirsch ◽  
Martin Koyle ◽  
Tony Chaviano ◽  
...  
Keyword(s):  
Vesicoureteral Reflux ◽  
Collaborative Research ◽  
Training Programs ◽  
Visual Learning ◽  
Learning Method ◽  
Surgical Results ◽  
Endoscopic Injection ◽  
Electronic Nature ◽  
Skill Performance ◽  
Endoscopic Correction

Herein we describe a standardized approach to teach endoscopic injection therapy to repair vesicoureteral reflux utilizing the CEVL method, an internet-accessed platform. The content was developed through collaboration of the authors' clinical and computer expertises. This application provides personnel training, examination, and procedure skill documentation through the use of online text with narration, pictures, and video. There is also included feedback and remediation of skill performance and teaching “games.” We propose that such standardized teaching and procedure performance will ultimate in improved surgical results. The electronic nature of communication in this journal is ideal to rapidly disseminate this information and to develop a structure for collaborative research.

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

2008 ◽  
Vol 2008 ◽  
pp. 1-7 ◽  
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.

scholarly journals Use of Polyacrylamide Hydrogel for Vesicoureteral Reflux Treatment, a Review

2019 ◽  
Vol 1 (1) ◽  
pp. 2-6
Author(s):  
Francis Lemire ◽  
Anne-Sophie Blais ◽  
Katherine Moore ◽  
Stephane Bolduc
Keyword(s):  
Minimally Invasive ◽  
Vesicoureteral Reflux ◽  
De Novo ◽  
Major Complication ◽  
Infectious Complications ◽  
Bulking Agent ◽  
Bulking Agents ◽  
Polyacrylamide Hydrogel ◽  
Endoscopic Injection ◽  
Significant Difference

Purpose of the review: Vesicoureteral reflux (VUR) is a common pathology encountered in pediatric urology. If left untreated, this condition can lead to infectious complications, hypertension and loss of renal function by scars. There is a trend for minimally invasive procedures to minimise treatment-related complications. Endoscopic subureteral injection of bulking agent in the treatment of VUR is an example of minimally invasive options. Several bulking agents have been studied and the perfect agent has not yet been discovered. Polyacrylamide hydrogel is a relatively new agent used to treat VUR and its use will be reviewed. Recent findings: Three modern studies from a Canadian group have evaluated the use of polyacrylamide hydrogel for endoscopic injection to treat VUR. The first study reported a cure rate of 81.2% without major complication. In the second study, injection of polyacrylamide hydrogel was compared to dextranomer hyaluronic acid and no significant difference was observed, with overall success rate of 73.1% and 77.5% respectively. The third trial evaluated the long-term efficacy and safety of polyacrylamide hydrogel with a 36-month follow-up. Overall success at 3 months was 70.7% and no patient had de novo hydronephrosis or calcification of the agent at 36 months. Conclusion: Polyacrylamide hydrogel seems to be a safe and effective alternative bulking agent in the treatment of VUR. The contribution from other centers to validate those data would be valuable.

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.

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.

181: Ordinary Glass Sphere as an Alternative Injectable Material for Endoscopic Correction of Vesicoureteral Reflux

2004 ◽  
Vol 171 (4S) ◽  
pp. 48-48
Author(s):  
Ferruh Simsek ◽  
Selcuk Yucel ◽  
Mustafa Aktas ◽  
Levent N. Turkeri
Keyword(s):  
Vesicoureteral Reflux ◽  
Glass Sphere ◽  
Endoscopic Correction
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