Abstract
Purpose. In recent years, endoscopic injection became the procedure of choice for the correction of vesicoureteral reflux in the majority of the centers. Unfortunately, endoscopic treatment is not always successful and sometimes requires more than one trial to achieve similar results to that of an open reimplantation surgery. Our aim of this study is to evaluate the feasibility and success rate of open ureteral reimplantation following failed endoscopic procedure. Patients and Methods. During 2004–2010, we evaluated 16 patients with persistent vesicoureteral reflux (grades II–IV) following failed endoscopic treatment. All patients underwent open ureteral reimplantation. All patients were followed with an ultrasound 6 weeks following surgery and every 6 months thereafter for an average of 22 months. Voiding cystography was performed at 3 months after surgery. Results. During unilateral open ureteral reimplantation, the implanted deposit from previous procedures was either excised, drained, or incorporated into the neotunnel with the ureter. Vesicoureteral reflux was resolved in all patients with 100% success rate. No new hydronephrosis or signs of obstruction developed in any of the patients. qDMSA renal scan was available in 8 patients showing improvement of function in 5 and stable function in 3, and no new scars were identified. Conclusions. Open ureteral reimplantation is an excellent choice for the correction of failed endoscopic treatment in children with vesicoureteral reflux.
Highlights
Vesicoureteral reflux (VUR) is a common occurrence in the pediatric age group resulting in potentially dangerous morbidities
We report our experience with open ureteral reimplantation (OUR) for the correction of unsuccessful endoscopic implant and our evaluation of its viability and success rate when compared to other minimally invasive procedures
voiding cystourethrogram (VCUG) performed in all patients three months after the operation showed complete resolution of the VUR. qDMSA scan available in 8 patients showed improved function in 5 and stable function in 3
Summary
Vesicoureteral reflux (VUR) is a common occurrence in the pediatric age group resulting in potentially dangerous morbidities. Patients are managed conservatively by observation or medically with prophylactic antibiotics. For those patients who require interventional approach, the focus is given to selecting the best corrective endoscopic or surgical option. As more long-term follow-up studies emerge, the results indicate that endoscopic treatment has a lower success rate and a higher recurrence than open ureteral reimplantation surgery. Some authors do not recommended to proceed with Deflux treatment, after the procedure has failed in several attempts, due to lower success rate with each consequent injection [8]. We report our experience with open ureteral reimplantation (OUR) for the correction of unsuccessful endoscopic implant and our evaluation of its viability and success rate when compared to other minimally invasive procedures
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