1256 TIMING OF RADIOLOGIC REFLUX ON VOIDING CYSTOURETHROGRAM PREDICTS HYDRODISTENTION GRADE BUT DOES NOT PREDICT SHORT TERM TREATMENT OUTCOMES

Abstract

You have accessJournal of UrologyPediatrics: Imaging Genital & Urinary Tract/Infections and Vesicoureteral Reflux/Andrology - Cryptorchidism & Varicoceles1 Apr 20101256 TIMING OF RADIOLOGIC REFLUX ON VOIDING CYSTOURETHROGRAM PREDICTS HYDRODISTENTION GRADE BUT DOES NOT PREDICT SHORT TERM TREATMENT OUTCOMES Justin Watson, Jonathan Kaye, Hal Scherz, and Andrew Kirsch Justin WatsonJustin Watson More articles by this author , Jonathan KayeJonathan Kaye More articles by this author , Hal ScherzHal Scherz More articles by this author , and Andrew KirschAndrew Kirsch More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.801AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Low pressure, early cycle reflux on VCUG is associated with a low chance of spontaneous resolution when compared to late filling or voiding reflux. We sought to determine if the timing of VUR on VCUG 1)correlates with ureteral hydrodistention (HD) grade and 2) predicts the outcome of endoscopic surgery. METHODS The records of 115 patients consecutively treated by two surgeons by the HIT injection method for VUR were examined. Twenty-five patients were excluded due to lack of VCUG, leaving 90 patients with 132 refluxing ureters. All VCUGs were examined by a urologist and radiologist for grade and timing of reflux. Sixty three (48%) of refluxing ureters or 44/90 patients were studied with more than one VCUG prior to intervention. Fourteen patients underwent three or more preoperative VCUGs. Each preoperative VCUG was examined for timing of VUR. Intraoperative hydrodistention grades (HD) were recorded for each ureter and a three month postoperative VCUG was obtained on each patient. RESULTS Average time between first VCUG and operative intervention was 328 days. The timing of reflux on both initial VCUG and immediately preoperative VCUG was statistically significantly correlated with HD grade intraoperatively. Severity of reflux on initial VCUG correlated with severity of HD grade (Somers'D 0.004) when classified by “early/ late/voiding” and (Somers'D 0.052)when classified by “filling, voiding”. Severity of reflux on immediately preop VCUG correlates with severity of HD grade (Somers'D 0.032) when classified by “early/late/voiding” but is not significant when classified by “filling/voiding” (Somers'D 0.302). The success rate of endoscopic treatment per ureter for early filling reflux, late filling reflux and voiding reflux based upon initial VCUG was 90.9% (40/44), 82.8% (53/64) and 93.3% (14/15) respectively. These differences were not significant (Pearson's Chi-square 0.539). Categorized by only filling or voiding reflux, these success rates are 86.1% (93/108) and 93.3% (14/15) (Pearson chi-square 0.726). CONCLUSIONS A uniformly high surgical success was achieved despite the timing of reflux during the bladder cycle or degree of ureteral HD. Our data confirm the anatomic basis for low pressure, early cycle reflux and delayed spontaneous resolution as abnormally high ureteral HD. These data support the need for standardized radiographic reporting. Atlanta, GA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e486 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Justin Watson More articles by this author Jonathan Kaye More articles by this author Hal Scherz More articles by this author Andrew Kirsch More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...