MP54-17 BEYOND VUR GRADING AND SURGICAL TECHNIQUE: PATIENT-BASED PARAMETERS SIGNIFICANT FOR SUCCESS OF ENDOSCOPIC ANTIREFLUX SURGERY

Abstract

You have accessJournal of UrologyPediatrics: Urinary Tract Infections/Vesicoureteral Reflux1 Apr 2015MP54-17 BEYOND VUR GRADING AND SURGICAL TECHNIQUE: PATIENT-BASED PARAMETERS SIGNIFICANT FOR SUCCESS OF ENDOSCOPIC ANTIREFLUX SURGERY Gina Cambareri, George Chiang, and Madhu Alagiri Gina CambareriGina Cambareri More articles by this author , George ChiangGeorge Chiang More articles by this author , and Madhu AlagiriMadhu Alagiri More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2040AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Successful treatment with dextranomer/hyaluronic acid copolymer, or Deflux®, historically has been quantified by the grade of vesicoureteral reflux present however other factors may determine a successful outcome. Herein we report prognostic factors that may be associated with successful Deflux® outcome. METHODS A retrospective review was performed in children who presented with vesicoureteral reflux (VUR) and underwent Deflux® from 2010-2013. Seven variables were analyzed to assess for prognostic significance including age, amount of Deflux® used, type of VUR (filling vs. voiding), presence of scarring on DMSA, history of bladder bowel dysfunction (based on clinical symptoms and DVSS scores when available), improvement in bladder and bowel dysfunction prior to Deflux® and clinical constipation. RESULTS A total of 301 patients met inclusion criteria for a total of 441 ureters (females 76.4%, average age 50.8 months). There were 55 ureters in grade 1, 151 ureters in grade 2, 195 ureters in grade 3, 31 ureters in grade 4 and 9 ureters in grade 5. Grade 1 VUR did not show significance for any variable on univariate or multivariate analysis. Failure of grade 2 VUR was more likely in children with a history of BBD (p=0.016) and clinical constipation (p=0.002) and more likely to resolve if the patient had improvement in BBD (p=0.001) on univariate analysis. Grade 3 VUR was more likely to fail if there was a history of BBD (p=0.002) and clinical constipation (p=0.001) on univariate analysis. On multivariate analysis patients with a history of BBD were more likely to fail (p = 0.044, OR 0.373). Patients with voiding VUR were more likely to be successful (p = 0.046, OR 2.271). Grades 4 and 5 were analyzed together and older patient age was prognostic of success (p=0.023) on univariate analysis. When analyzing the entire cohort, failure was more likely in patients with a history of BBD (p=0.002) and clinical constipation (p<0.001). Success was more likely in children with improved BBD the time of Deflux® (p<0.001). On multivariate analysis, patients with a history of constipation were more likely to have failed Deflux® (p = 0.006, OR 0.417). VUR on voiding was 1.64 times more likely to resolve successfully after one Deflux® injection (p = 0.043, OR 1.636). CONCLUSIONS We found that history of BBD and clinical constipation were more likely to predict failure in children treated with Deflux®. Children with improved BBD were more likely to benefit from Deflux®. These variables have important prognostic significance when deciding on treatment options in children with VUR. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e671 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gina Cambareri More articles by this author George Chiang More articles by this author Madhu Alagiri More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...