Abstract
Objective: To evaluate the treatment outcome of single session endoscopic treatment using Polyacrylate Polyalcohol Copolymer (PPC) (Vantris ®) compared with conservative Continuous Antibiotic Prophylaxis (CAP) and open surgical treatment among children with Vesico-Ureteral Reflux (VUR). Methods: A retrospective cohort was undertaken in a single institution to evaluate children diagnosed with primary VUR grade 2-4 from 2006-2012 treated by a single urologist with different treatment modalities- conservative continuous antibiotic prophylaxis, endoscopic correction with PPC and open ureteral re-implantation with Cohen technique. Included patients for the study were only those who had 1-3 months and >1 year post-treatment follow- up study with Voiding Cystourethrogram (VCUG), kidney ultrasound, Dimercaptosuccinic Acid (DMSA) renal scan, and urine culture. Comparative analysis was made to evaluate the rate of VUR resolution, reflux recurrence, renal scaring and VUR treatment related hospital stay. Results: Twenty-five children (12 girl and 13 boys) with a mean age of 3 ± 1.4 years were included. Twelve children had bilateral VUR and thirteen had unilateral VUR, a total of thirty-seven Refluxing Renal Units (RRU) were being analyzed (12 CAP, 11 endoscopic corrections and 14 open re-implantation surgery). On initial 3 months post-treatment follow-up, RRU VUR resolution observed for CAP, PPC and open surgery were 33% (4/12), 91% (10/11) and 100% (14/14), respectively. At >1 year post treatment follow-up, VUR resolution were noted in 50% (6/12) treated with CAP. For PPC treated group, 27% (3/11) had reflux recurrence or persistence and 14% (2/14) of open surgery group had ureteral obstruction with hydronephrosis. Renal scarring detected among CAP, PPC and surgery group at >1 year follow-up were 42% (5/12), 18% (2/11) and 14% (2/14), respectively. VUR treatment related mean hospital day per year was highest among the CAP group (6.25 ± 2.6 days/year) and lowest among PPC group (3.27 ± 1.2 days/year). Conclusion: Endoscopic correction of VUR with PPC resulted to better treatment outcome when compared to CAP and was comparable to open surgical management with shorter treatment related hospital stay.
Highlights
Retrograde urine flow from the bladder into the upper collecting system, termed Vesicoureteral Reflux (VUR), is a functional and anatomical disorder that affects nearly 1% of the children [1]
All subjects diagnosed with VUR treated with conservative management, single-injection endoscopic correction or surgical management was included for comparative analysis
Twenty-five patients (13 girls and 12 boys) with a mean age of 3 ± 1.4 years old diagnosed with VUR grade II-IV, according to the International Reflux Study Classification, were included in the study
Summary
Retrograde urine flow from the bladder into the upper collecting system, termed Vesicoureteral Reflux (VUR), is a functional and anatomical disorder that affects nearly 1% of the children [1]. This condition if treated inappropriately may result to potentially serious sequel, such as renal scarring, hypertension and renal failure [2]. The ultimate objective of VUR management is to preserve the renal function and minimize risk of long-term complications through prevention of febrile urinary tract infection. A balance between risk prevention and overtreatment should be considered in providing treatment, among patients with grade II-IV VUR
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