Abstract
BackgroundTo 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.MethodsWe 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.ResultsFrom 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.ConclusionsAccording 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.
Highlights
To investigate the efficacy and safety of endoscopic injection therapy for vesicoureteral reflux in postpubertal patients with dilated ureteral orifice via modified hydrodistension implantation techniques
The use of endoscopic injection therapy has increased since the injectable agents and techniques have been refined, resulting in subureteral transurethral injection (STING), hydrodistension implantation technique (HIT), and double-HIT procedure [6,7,8]
The present study investigated the efficacy and safety of endoscopic injection therapy for Vesicoureteral reflux (VUR) in adults via modified HIT techniques adopted for large-caliber ureters
Summary
To investigate the efficacy and safety of endoscopic injection therapy for vesicoureteral reflux in postpubertal patients with dilated ureteral orifice via modified hydrodistension implantation techniques. The use of endoscopic injection therapy has increased since the injectable agents and techniques have been refined, resulting in subureteral transurethral injection (STING), hydrodistension implantation technique (HIT), and double-HIT procedure [6,7,8]. This minimally invasive therapy is a new option for the treatment of VUR in children [9]. There is little information regarding the clinical utility of the therapy partially due to the limited number of patients or such technical difficulties associated with large-caliber ureter or might be pathological stiffness originated from chronic inflammation in the adult ureter
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
