Endoscopic correction of vesicoureteral reflux in children with solitary functioning kidney: insertion of a double-J stent to avoid transient ureteral obstruction.

Abstract

Children with solitary functioning kidney, especially those with concomitant vesicoureteral reflux, are at increased long-term risk of kidney damage. Acute obstruction is a rare but relevant concern after endoscopic correction of vesicoureteral reflux and might be more symptomatic in children with solitary functioning kidney. We hereby report our experience and routine practice in using ureteral stents for prevention of the potential acute obstruction after endoscopic correction of reflux in children with solitary functioning kidney. A retrospective chart review was performed to find children with solitary functioning kidney that were endoscopically treated for vesicoureteral reflux. Solitary functioning kidney was defined as congenital or acquired (contralateral renal function <10 % in dimercaptosuccinic acid scan). Data regarding age, sex, grade and side of vesicoureteral reflux, and follow-up information were gathered. A tethered double-J stent was inserted after endoscopic bulking agent injection in all patients. Stents were removed using the extraction string at 2 weeks postoperatively. Between 2008 and 2015, a total of 28 patients (16 females) with solitary functioning kidney were treated endoscopically and underwent concomitant double-J insertion. Reflux was grade II in 12 (42.9 %), grade III in 10 (35.7 %), and grade IV in 6 (21.4 %) patients before treatment. No complication was encountered postoperatively or at removal of the stents using extraction strings. Considering devastating sequelae of acute obstruction following endoscopic management of reflux in children with solitary functioning kidney, routine use of double-J stents might be a feasible and safe approach.