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.

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 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 Subureteral Injection with Small-Size Dextranomer/Hyaluronic Acid Copolymer: Is It Really Efficient?

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Iyimser Üre ◽  
Serhat Gürocak ◽  
Özgür Tan ◽  
Amirali Farahvash ◽  
Cem Senol ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Success Rate ◽  
Vesicoureteral Reflux ◽  
Low Cost ◽  
Clinical Results ◽  
Voiding Cystourethrogram ◽  
Complication Rates ◽  
Success Rates ◽  
Acid Copolymer ◽  
Urinary Infections

The aim of this study was to evaluate the clinical results of patients with vesicoureteral reflux, which were treated with subureteral injection of small-size (80–120 μm) dextranomer/hyaluronic acid copolymer (Dx/HA). Data of 75 children (105 renal units) who underwent STING procedure with small-size Dx/HA for the treatment of vesicoureteral reflux (VUR) in our clinic between 2008 and 2012 were retrospectively analyzed. Preoperative reflux grade and side, injection indication, postoperative urinary infections and urinary symptoms, voiding cystourethrogram, and renal scintigraphy results were evaluated. The success rate of the procedure was 100% in patients with grades 1 and 2 reflux, 91% in patients with grade 3 reflux, and 82.6% in patients with grade 4. Overall success rate of the treated patients was 97%. Endoscopic subureteric injection with Dx/HA procedure has become a reasonable minimally invasive alternative technique to open surgery, long-term antibiotic prophylaxis, and surveillance modalities in treatment of VUR in terms of easy application, low costs and complication rates, and high success rates. Injection material composed of small-size dextranomer microspheres seems superior to normal size Dx/HA, together with offering similar success with low cost.

scholarly journals The “incidental anesthetic” — an opportunity for the endoscopic correction of vesicoureteral reflux in children

2013 ◽  
Vol 3 (3) ◽  
pp. 225
Author(s):  
Elena Tamarkina ◽  
Mohammed El-Sherbiny ◽  
Roman Jednak ◽  
John-Paul Capolicchio
Keyword(s):  
Vesicoureteral Reflux ◽  
Prise En Charge ◽  
Endoscopic Management ◽  
First Line Therapy ◽  
Acid Copolymer ◽  
Line Therapy ◽  
Endoscopic Correction ◽  
The Cost ◽  
Acide Hyaluronique

Introduction: The endoscopic management of vesicoureteral reflux(VUR) with subureteric injection (STING) has become more popular.The low morbidity associated with the STING procedure hasled to some authors advocating its use as a first-line therapy. Manyparents are uncomfortable with this procedure being performedin children because of the potential morbidity associated with generalanesthesia. We present an alternative without added anestheticmorbidity: offering the parents a STING when their childis undergoing an anesthetic for another surgical indication.Methods: We reviewed the records of 10 children who underwentincidental dextranomer/hyaluronic acid copolymer (DHA) injectionover a 2-year period.Results: We considered the treatment outcome after a single STINGprocedure to be successful in 8 (80%) patients and a failure in 2(20%). Distribution of VUR grade, according to the highest gradeper patient, was high in 5 (50%) patients, moderate in 3 (30%)and low in 2 (20%). We observed no complications.Conclusion: The idea of performing STING in children under incidentalanesthetic introduces yet another possibility in the paradigmof VUR care. Though the long-term efficacy of DHA remains to bedetermined, this option reduces the potential morbidity of DHA asfirst-line therapy while favourably altering the cost benefit.Introduction : L'injection sub-urétérale endoscopique est uneméthode de plus en plus utilisée pour la prise en charge d'un refluxvésico-urétéral (RVU). La faible morbidité associée à cette techniquea amené certains auteurs à recommander son emploi entraitement de première ligne. Bien des parents ne sont pas à l'aiseavec cette suggestion en raison du risque de morbidité lié àl'anesthésie générale. Nous présentons ici une solution de rechangequi n'augmente pas la morbidité liée à l'anesthésie, soit le recoursà l'injection sub-urétérale endoscopique pendant que l'enfantest déjà sous anesthésie pour une autre intervention chirurgicale.Méthodes : Les dossiers de 10 enfants ayant subi une injectionde copolymère de dextranomère / acide hyaluronique (DxAH) aucours d'une période de 2 ans ont été passés en revue.Résultats : Après une seule injection sub-urétérale, l'issue du traitement a été jugée excellente chez 8 patients (80 %) et un écheca été constaté chez 2 patients (20 %). La distribution des stadesde RVU en fonction du stade le plus élevé noté chez chaque patientétait la suivante : grade élevé, 50 %, modéré, 30 % et faible, 20 %.Aucune complication n'a été observée.Conclusion : L'idée de recourir à une injection sub-urétérale pendantune autre intervention nécessitant une anesthésie ajoute uneoption dans l'algorithme de traitement du RVU. Même si l'efficacitéà long terme du DxAH reste à établir, cette option a l'avantagede réduire le risque de morbidité lié au DxAH comme traitementde première ligne tout en modifiant pour le mieux l'équationcoûts-avantages.

scholarly journals A Review of the Effect of Injected Dextranomer/Hyaluronic Acid Copolymer Volume on Reflux Correction Following Endoscopic Injection

2008 ◽  
Vol 2008 ◽  
pp. 1-5
Author(s):  
Sumit Dave ◽  
Darius J. Bägli
Keyword(s):  
Hyaluronic Acid ◽  
Prospective Studies ◽  
Vesicoureteric Reflux ◽  
Continuous Variable ◽  
Injection Technique ◽  
Success Rates ◽  
Endoscopic Injection ◽  
Acid Copolymer ◽  
Endoscopic Correction ◽  
Multiple Variables

The current literature suggests that multiple variables affect vesicoureteric reflux (VUR) resolution rates following dextranomer/hyaluronic acid copolymer (Dx/HA) injection. This article reviews the evidence pertaining to the effect of injected Dx/HA volume on success rates following endoscopic correction. Lack of prospective studies which use injected volume as a continuous variable coupled with a nonstandardized injection technique and endpoint hinders the ability to reach a definite conclusion.

scholarly journals Outcomes of Extravesical Versus Intravesical Ureteral Reimplantation

2004 ◽  
Vol 4 ◽  
pp. 195-197
Author(s):  
Leah P. McMann ◽  
Byron D. Joyner
Keyword(s):  
Length Of Stay ◽  
Vesicoureteral Reflux ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Renal Ultrasound ◽  
Voiding Cystourethrogram ◽  
Ureteral Reimplantation ◽  
Success Rates ◽  
Average Length Of Stay

Purpose: The purpose of our study was to examine outcomes and compare length of stay after extravesical and intravesical ureteral reimplantation at our institution. Materials and Methods: Retrospective review was performed of 30 patients (55 ureters) with vesicoureteral reflux who underwent either the Cohen (intravesical) cross-trigonal procedure or the extravesical (detrusorrhaphy) approach. Each patient had documented follow-up consisting of a postoperative renal ultrasound and/or a voiding cystourethrogram (VCUG). Inclusion criteria was the presence of primary vesicoureteral reflux. Exclusion criteria were patients who had undergone a previous repair and patients in whom results of neither the renal ultrasound nor the VCUG were available. Results: There were no significant cases of obstruction or wound infection with either approach. Two patients who underwent the extravesical approach had persistent reflux on VCUG three months postoperatively, but both resolved by fifteen months. Average length of stay was only 3.00 ± 1.33 days for the extravesical approach, compared to 5.36 ± 1.75 days for the intravesical approach ( P = .0003 ). Conclusions: Given that by fifteen months success rates were the same with either approach, the extravesical approach is comparable to the intravesical technique and is a viable option in terms of outcome and economics given the shorter length of hospital stay.

Learning From the Learning Curve: Factors Associated With Successful Endoscopic Correction of Vesicoureteral Reflux Using Dextranomer/Hyaluronic Acid Copolymer

2008 ◽  
Vol 180 (4S) ◽  
pp. 1594-1600 ◽  
Author(s):  
Sumit Dave ◽  
Armando J. Lorenzo ◽  
Antoine E. Khoury ◽  
Luis H.P. Braga ◽  
Sean J. Skeldon ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Learning Curve ◽  
Vesicoureteral Reflux ◽  
Factors Associated ◽  
Acid Copolymer ◽  
Endoscopic Correction

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

An Epidemic Avian Influenza Prediction Model Based on Google Trends

2019 ◽  
Vol 16 (4) ◽  
pp. 303-310 ◽  
Author(s):  
Yi Lu ◽  
Shuo Wang ◽  
Jianying Wang ◽  
Guangya Zhou ◽  
Qiang Zhang ◽  
...  
Keyword(s):  
Linear Regression ◽  
Avian Influenza ◽  
Prediction Model ◽  
Multiple Linear Regression ◽  
Google Trends ◽  
Health Providers ◽  
Human Beings ◽  
Success Rates ◽  
New Model ◽  
Regression Approach

The occurrence of epidemic avian influenza (EAI) not only hinders the development of a country's agricultural economy, but also seriously affects human beings’ life. Recently, the information collected from Google Trends has been increasingly used to predict various epidemics. In this study, using the relevant keywords in Google Trends as well as the multiple linear regression approach, a model was developed to predict the occurrence of epidemic avian influenza. It was demonstrated by rigorous cross-validations that the success rates achieved by the new model were quite high, indicating the predictor will become a very useful tool for hospitals and health providers.

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