Abstract
Endoscopic treatment of vesicoureteral reflux (VUR) is feasible in pediatric patients. As endoscopic injection has a lower success rate than ureteral reimplantation, a postoperative voiding cystourethrogram (VCUG) is usually performed. The present study evaluated whether the presence of a nodule on noninvasive ultrasound could predict the resolution of VUR and replace invasive VCUG. Patients who received an injection of endoscopic bulking agent for VUR from January 2005 to December 2010 were evaluated retrospectively. It was evaluated whether a nodule, an echogenic mass lesion distinguished from the bladder at the ureteral orifice, was present on the ultrasound one month postoperatively. The success of the injection in the group with nodules was compared with that of the group without nodules by VCUG 3 months postoperatively. A total of 149 patients (220 ureters) met the inclusion criteria. The mean age at surgery was 3.5 years (range, 0.6–18 years). The overall success rate was 73.2%. A nodule was present in 152 cases (69.1%). The group with nodules had a higher success rate than the group without nodules (84.2%, 128/152 vs. 48.5%, 33/68, respectively; P<0.001). According to multivariate analysis, injection nodules were a predictive factor for the success of the endoscopic injection (odds ratio, 6.050; P<0.001). The failure rate increased with increasing injection volume. The sensitivity of sonographic injection nodules for predicting success was 79.5% and the specificity was 59.3%. To conclude, the presence of a postoperative nodule can predict the resolution of VUR.
Highlights
Since it was first introduced by Matouschek [1] in 1981 and independently proposed by O'Donnell and Puri [2] in 1984, endoscopic injection has become popular for treating vesicoureteral reflux (VUR) due to its simplicity
The spread of endoscopic treatment accelerated with the introduction of dextranomer/hyaluronic acid (Dx/HA)
The rate of VUR resolution following injection treatment is lower than that following open ureteral reimplantation
Summary
Since it was first introduced by Matouschek [1] in 1981 and independently proposed by O'Donnell and Puri [2] in 1984, endoscopic injection has become popular for treating vesicoureteral reflux (VUR) due to its simplicity. Due to its advantages, including technical ease, minimal invasiveness, low complication rate and short hospital stay, endoscopic treatment is a viable alternative to open ureteral reimplantation. The rate of VUR resolution following injection treatment is lower than that following open ureteral reimplantation. Open ureteral reimplantation has a high success rate (94‐99%) in correcting VUR, regardless of technique [4]. Certain urologists insist that routine postoperative voiding cystourethrography (VCUG) is not necessary following open ureteral reimplantation [5,6,7,8]. The AUA recommends that following open surgical or endoscopic procedures for VUR, a renal ultrasound should be performed 1 month postoperatively to determine whether there are any obstructions [9]. The present study evaluated whether the presence of an injection nodule on ultrasound can predict the resolution of VUR and replace invasive VCUG.
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