Endoscopic Correction Research Articles

What are the predictive factors leading to ureteral obstruction following endoscopic correction of VUR in the pediatric population?

It is extremely important to not only address the short-term success following endoscopic correction of vesicoureteral reflux (VUR) but also the long-term efficacy and safety of the tissue augmenting substance utilized for endoscopic correction. This study retrospectively evaluated all cases of ureterovesical junction (UVJ) obstruction following endoscopic treatment of VUR over the last 5 years utilizing two tissue augmenting substances, with special emphasis on the safety of Vantris®, and performed clinical and histological review of these patients. The study population comprised 2495 patients who underwent endoscopic correction of VUR utilizing Deflux® (1790) and Vantris® (705). Tissue sections were stained with hematoxylin & eosin and trichrome, and examined under a light microscope. Nine primary obstructive megaureters after ureteral re-implantation served as controls. Nine (0.5%) children (three female and six male) in the Deflux group and nine (1.3%) (five females and four males) in the Vantris group developed UVJ obstruction and required ureteral re-implantation. Obstruction developed during the period ranging 2-49 months (average 16 months) following endoscopic correction. The primary reflux grade was III in seven, IV in six, and V in six children. The mean volume of the injected material in all obstructed patients was 1.2±0.6cc (mean±SD). Histopathological analysis revealed a pseudocapsule composed of fibrous tissue and foreign-body giant cells surrounding the Vantris implant in all patients. The distal part of the ureters demonstrated significant ureteral dilatation without ureteral fibrosis. In all patients, additional biopsies from the muscularis propria adjacent to the injection site were examined and showed no significant abnormalities. There was an increased collagen deposition in the juxtavesical segment of the obstructive ureters following Deflux and Vantris injections, and of primary obstructive megaureter. No significant difference was found in the tissue response between Deflux and Vantris patients and controls. Statistical analysis of the nonhomogeneous population demonstrated higher obstruction rates in patients from the Vantris group. However, no statistical difference was demonstrated regarding the obstruction rate in the homogenous group with relation to gender, age and reflux grade group of patients. Moreover, univariate analysis revealed that Grade V reflux, the presence of beak sign on the reviewed pretreatment, and inflamed bladder mucosa upon injection were significant independent risk factors leading to obstruction. This study suggested that the underlining ureteral pathology lead to UVJ obstruction following Vantris injection. There was increased collagen deposition in the juxtavesical segment of the obstructive ureters following Vantris injection. Furthermore, these findings were similar to those discovered in patients who underwent endoscopic correction with Deflux, and in patients who required ureteral reimplantation due to primary obstructive megaureter. Additional biopsies from the muscularis propria adjacent to the injection site showed no significant abnormalities, ironing out the fact that Vantris did not led to adverse tissue reaction following injection. Univariate analysis further ironed out the hypothesis that underlying ureteral pathology was responsible for the increased incidence of UVJ obstruction and demonstrated that Grade V reflux, the presence of beak sign on the reviewed pretreatment VCUG, and inflamed bladder mucosa upon injection were significant independent risk factors leading to obstruction. Data showed that Vantris injection did not lead to any different ureteral fibrosis or inflammatory changes to the tissue augmenting substances utilized in past and present clinical practice, and therefore did not seem to increase the incidence of UVJ obstruction. High reflux grade, presence of obstructive/refluxing megaureter and inflamed bladder mucosa were the only statistically significant and independent predictive factors for UVJ obstruction following endoscopic correction of VUR.

The Relationship Between Vesicoureteral Reflux and Recurrent Urinary Tract Infection in Children in Kurdistan Region, Iraq

Background: Recurrent urinary tract Infection (UTI) is a common problem in pediatric age group. Vesicoureteral reflux (VUR) is a common cause for recurrent UTI. Objectives: This study was conducted to determine the prevalence of VUR in children who presented with recurrent UTIs and to assess the effect of endoscopic treatment in patients with grade III-V VUR. Methods: This was a prospective study recruiting 1232 patients who presented with recurrent UTI during April 2008 and January 2012. We used voiding cystourethrogram to diagnose VUR, and treated grades III-V VUR by bulking agent. One to 2 sessions were performed and the participants were followed-up postoperatively at first, second, third, and 12th months postoperatively. Results: VUR was found in 437 (35.5%) of the patients. Amongst those, 197 (16%) patients were diagnosed with VUR grade I and II. Additionally, 240 (19.5%) cases were diagnosed with VUR III-V. Two sessions were required to correct the reflux in all patients with grade III. The success rate of correction of grade IV was 79% after the second session. The success rate was 71% in grade V. New contralateral reflux with low grade (I and II) de novo VUR was found in 28/240 (11.7%) cases. After successful correction of VUR, UTI occurred in 12/203 (5.9%) of the patients. Conclusions: VUR was common in children with recurrent UTI with a good prognosis after endoscopic correction. Further study is needed to follow-up the participants who did not respond to treatment.

Does endoscopic puncture of ureterocele provide not only an initial solution, but also a definitive treatment in all children? Over the 26years of experience.

We have retrospectively evaluated all patients who underwent endoscopic puncture (EP) of ureterocele over the last 26years with special reference to the need in the second intervention and disease-free status. 78 (69%) of the 112 patients following EP and completed follow-up were included. 51 (65%) were diagnosed prenatally and 27 (35%) postnatally. 46 patients (60%) had intravesical, while 32 (40%) had ectopic ureterocele. Median age at time of puncture was 4months. Median time of the follow-up was 12years (range 1-26years), while 23 (30%) followed over 10years and 15 (19%) completed adolescent period. Four children with ectopic ureterocele required secondary puncture. Ectopic ureterocele children had significantly more postoperative UTIs (13 (40%) ectopic vs 4 (19%) intravesical p = 0.047). 19 RRUs (44%) showed spontaneous resolution of VUR. 14 (18%) children required additional surgery: 7, endoscopic correction of VUR; 3, ureteral reimplantation and 4, partial nephrectomy. The need for additional surgery following puncture was higher in the group of children with ectopic ureterocele; however, this difference did not reach a statistical significance (p = 0.716). Our data show that EP of ureterocele is a durable and long-term effective procedure in vast majority of the children.

Endoscopic Injection of Dextranomer/Hyaluronic Acid as First Line Treatment in 851 Consecutive Children with High Grade Vesicoureteral Reflux: Efficacy and Long-Term Results

Endoscopic injection of dextranomer/hyaluronic acid is widely acknowledged as first line treatment of lower grade vesicoureteral reflux. We demonstrate its long-term efficacy and safety in eradicating high grade reflux. A total of 518 girls and 333 boys with a median age of 2.3 years (range 2 months to 13.7 years) underwent endoscopic correction of high grade vesicoureteral reflux using dextranomer/hyaluronic acid. Reflux was unilateral in 415 cases and bilateral in 436, comprising 1,287 refluxing units. Reflux was grade IV in 1,153 ureters (89.6%) and grade V in 134 (10.4%). 99mTechnetium-dimercaptosuccinic acid scintigraphy identified renal scarring in 317 patients (37.3%). Followup ultrasound and voiding cystourethrogram were performed 3 months after intervention and renal ultrasound yearly thereafter. Median followup was 8.5 years (range 6 months to 16 years). Overall resolution rate after the first endoscopic injection was 69.5% (895 of 1,287 cases), with resolution in 70.4% of grade IV and 61.9% of grade V cases. Reflux resolved after a second injection in 259 cases (20.1%) and after a third injection in 133 (10.4%). Persistent reflux after initial treatment was significantly more common in patients younger than age 1 year and in individuals with renal scarring. No significant postoperative complications were observed and no patient required ureteral reimplantation. Following reflux resolution febrile urinary tract infection developed in 43 children (5.1%), including 24 (55.8%) during the first year, 15 (34.9%) during the second year and 4 (9.3%) during year 3 or later. Of these patients 6 had reflux recurrence and 8 had neocontralateral grade III reflux, which was successfully treated with a single endoscopic injection of dextranomer/hyaluronic acid. Endoscopic injection of dextranomer/hyaluronic acid is an efficient and safe long-term treatment for grade IV and V vesicoureteral reflux, and can easily be repeated in patients with treatment failure with a high subsequent resolution rate.

The effect of prior endoscopic correction of vesicoureteral reflux on open ureteral reimplantation: Surgical outcomes and costs

Endoscopic injection of a bulking agent is a common first-line approach to the treatment of vesicoureteral reflux (VUR). While early outcomes are comparable to open ureteroneocystotomy, 5-25% of children will eventually develop recurrent reflux necessitating repeat injections or open ureteral reimplantation. To determine whether prior endoscopic injection of a bulking agent impacts outcomes of subsequent open ureteral reimplantation. Using a retrospective cohort design, radiographic and clinical outcomes of open ureteral reimplantation were compared between patients with and without prior endoscopic correction of reflux. Surgical and hospitalization data were also compared between groups and a cost comparison was performed to assess differences in healthcare costs between the two cohorts. Units of analysis included total ureters or total patients. For certain variables, subanalysis of unilateral versus bilateral reimplantation was included. A total of 258 patients underwent open reimplantation for VUR between 2007 and 2016 by five pediatric urologists. Final analysis (see Summary Table) included 192 patients with pre-operative and postoperative voiding cystourethrogram (VCUG) and follow-up data at a median 4.95 months. Among 317 reimplanted refluxing ureters, radiographic resolution was reached in 26/27 (96.3%) patients with and 279/290 (96.2%) without prior endoscopic treatment (P=0.981). Clinical success was achieved in 17/17 (100%) patients with and 174/175 (99.4%) without prior endoscopic treatment (P=0.755). There were no statistically significant differences between duration of surgery or length of hospital stay. There were no statistically significant differences between total charges, total costs, and operating room (OR) costs between groups. This study indicated that prior endoscopic injection of a bulking agent did not impact the outcomes or costs of subsequent open ureteroneocystotomy. While prior studies have demonstrated tissue changes associated with injection of a bulking agent, these did not seem to significantly impact the difficulty of later open surgery or the success rates compared to patients who proceeded directly to open correction of reflux. Open ureteral reimplantation for recurrent VUR after failed endoscopic injection of a bulking agent was safe and effective, with comparable outcomes and costs to open surgery in patients without prior endoscopic correction.

Endoscopic correction of vesicoureteral reflux in children

Introduction: Dextranomer/hyaluronic (Dx/HA) acid is the only tissue-augmenting agent approved by the Food and Drug Administration (FDA) for the vesicoureteral reflux (VUR) treatment. Objectives: We aimed to evaluate short-term outcomes of the Dx/HA in patients who had undergone subureteric injection. Patients and Methods: In this study, 30 patients with VUR diagnosis who had indications for open surgery were enrolled in the study. Patients underwent subureteric Dx/HA injection. Additionally patients underwent a one-year follow up period, subsequently. Follow up included urine analysis, urine cultures and kidney and urinary tract ultrasonography study. Results: Of a total 30 patients, 8 patients (27%) were male and 22 patients (73%) were female. The mean age of patients was 25.19 ± 0.70 months. Postoperative VUR resolution was observed in 28 patients (93.3%). Moreover, during one year follow up, urinary tract infection (UTI) was not reported in patients. However, recurrent VUR was detected in 8 patients (27%) during ultrasonography follow up. Analysis showed no significant difference of recurrence in VUR between males and females (P = 0.285) and VUR severity (P = 0.1). There was a significant relationship between recurrent UTI history before intervention and VUR recurrence after subureteric injection (P = 0.007). Conclusion: Dx/HA acid subureteric injection provides acceptable resolution rate among VUR patients, but its biodegradability causes VUR recurrence during one-year follow up.

Endoscopic Treatment of Vesicoureteral Reflux

Optimal management of primary vesicoureteral reflux (VUR) remains a source of debate, and options include observation with or without continuous antibiotic prophylaxis and surgical repair via endoscopic, open, or laparoscopic/robotic approaches. Surgical intervention may be necessary in children with persistent reflux, renal scarring, or recurrent febrile urinary tract infections when other options fail. Need for surgical correction is dictated predominantly by a given child’s clinical course including risk for recurrent infections and potential for renal scarring. While recent studies suggest that endoscopic injection is effective for the treatment of most VUR, the importance of material injected, technique utilized, reflux grade, and structural/functional bladder anomalies on ultimate success rates must be emphasized. Long-term clinical success following endoscopic correction of primary VUR is high, and the majority of children avoid additional or more invasive surgical procedures. Efficacy rates are known to vary widely between surgeons, techniques, and implant materials.

Anthropometric Outcome Measures in Patients With Metopic Craniosynostosis.

Treatment of metopic craniosynostosis is performed by either fronto-orbital advancement (FOA) or endoscopic-assisted techniques. Interfrontal angle (IFA) is a validated measure of trigonocephaly, but requires a computed tomography scan. The most common direct measure to assess surgical outcome in patients with trigonocephaly is frontal width (ft-ft). The aim of this study is to determine if frontal width correlates with IFA and successful surgical correction 1 year after treatment. A review of current morphologic assessment techniques is also provided. Three-dimensional computed tomography scans (preoperative and 1 year postoperative) of patients who underwent FOA (n = 13) or endoscopic (n = 13) treatment of metopic craniosynostosis were reviewed. Age-matched scans of unaffected patients served as controls. Frontal width was measured by a straight line between the bilateral frontotemporal points. Measurements were performed by 2 experienced observers and compared to IFA. Mean frontal width at preoperative scan for endoscopic and open patients was 55 ± 0.6 and 64 ± 0.7 mm, respectively (Z-score 1.6 and -3.7). Mean frontal width at postoperative scan for endoscopic and open patients was 80 ± 0.4 and 81 ± 0.7 mm (Z-score 0.0 for both groups). Frontal width for endoscopic correction significantly correlated with IFA (r = 0.536, P = 0.005), as well as for the open patients (r = 0.704, P < 0.001). Frontal width normalizes 1 year after operation, regardless of technique. Advantage of frontal width is that it can be measured in the clinic using a spreading vernier caliper. It correlates well with IFA and can be used as a metric for morphologic outcome.

Генітальний ендометріоз у жінок з гіпотиреозом: патогенез, тактика лікування та профілактика рецидивів

The objective: rising of efficiency of treatment of genital endometriosis in combination with hypothyrosis and depression of frequency of recurrence on the basis of improvement and introduction of algorithm diagnostic, medical prophylactical and rehabilitational actions with use of modern endoscopic technologies and medicamental correction. Patients and methods. Аt first was carried out the analysis of frequency of extragenital pathology at 789 patients with an internal genital endometriosis, then we surveyed 110 patients who received conservative and 100 patients – expeditious treatment. Research methods: clinical, laboratory, tool, functional, morphological and statistical. Results. Аt women with various forms of genital endometriosis obligatory inspection of funcshionale condition of thyroid gland, the endocrinologic and immunologic status is necessary; at vibor of a method of expeditious treatment of women with genital endometriosis and hypothyrosis the preference should be given to endoscopic and vaginal techniques, and also organ-preserving volume; for postoperative aftertreatment of women with genital endometriosis and hypothyrosis the preference should be given to hormonal therapy, courses not less 6 months. Conclusion. Introduction of the received results will allow to increase efficiency of treatment of genital endometriosis as is conservative, and operative that increases quality of life of women. Key words: genital endometriosis, hypothyrosis, pathogenesis, treatment.

Endoscopic injection therapy.

Since the U.S. Food and Drug Administration approved dextranomer/hyaluronic acid copolymer (Deflux) for the treatment of vesicoureteral reflux, endoscopic injection therapy using Deflux has become a popular alternative to open surgery and continuous antibiotic prophylaxis. Endoscopic correction with Deflux is minimally invasive, well tolerated, and provides cure rates approaching those of open surgery (i.e., approximately 80% in several studies). However, in recent years a less stringent approach to evaluating urinary tract infections (UTIs) and concerns about long-term efficacy and complications associated with endoscopic injection have limited the use of this therapy. In addition, there is little evidence supporting the efficacy of endoscopic injection therapy in preventing UTIs and vesicoureteral reflux-related renal scarring. In this report, we reviewed the current literature regarding endoscopic injection therapy and provided an updated overview of this topic.

Endoscopic correction of vesicoureteral reflux in children using polyacrylate-polyalcohol copolymer (Vantris): 5-years of prospective follow-up.

IntroductionThe endoscopic correction of vesicoureteral reflux (VUR) in children is a currently well accepted therapy in many pediatric urology centers. Polyacrylate-polyalcohol copolymer (PPC), namely Vantris®, is one of the tissue-augmenting substances used for endoscopic reflux therapy. The aim of this study was to evaluate the results with PPC in children.Material and methodsFrom 2012 to 2016, 125 children (73 girls and 52 boys) aged 0.6–17.9 years (mean 4.9 ±3.58) were treated with PPC. VUR was unilateral in 64 and bilateral in 61 patients, comprising 197 renal refluxing units (RRUs) grades: II in 72, III in 50, IV in 33 and V in 42. Of these primary reflux was present in 132 RRUs and 65 were complex cases. Voiding cystourethrogram (VCUG) was done 3 months after procedure.ResultsFollow-up was completed in 89.6% of patients (112 children), and 89.8% of RRUs (177 out of 197). Reflux resolved in 86.4% of RRUs after single injection, in 99.4% after second and in 100% after the third. The only significant, but serious complication observed was late ureteral obstruction after PPC injection correcting high grade reflux, which required ureteral re-implantation. This complication was found in 9 out of 112 children (8%), and in 11 out of 177 RRUs (6.2%), 1.1 -2.9 years (mean 2 ±0.7) after the PPC injection. The longest follow-up reaches 4.5 years.ConclusionsOur data show that the PPC injection is an effective procedure for treating all grades of VUR with high success rate. However, because of the possibility of late ureteral obstruction, which requires ureteroneocystostomy, long-term follow-up is mandatory.

Open laryngectomy: Clinical experience

Introduction. The problem of treatment and rehabilitation of patients with laryngeal cancer has been a complicated and controversial one. Important conditions for selection of the type and scale of functionally sparing surgical intervention are accurate preoperative diagnosis of advancement of the tumor and oncological appropriateness of the intervention. Currently, the problem of single-step reconstruction of lost laryngeal functions after organ-preserving surgeries remains open. For this purpose, researchers use both auto-/homografts and endoprosthetics made of various materials. In some cases, endoprosthetics in lyrengectomy didn’t allow to restore laryngeal lumen due to granulation tissue, cicatricial stenosis, laryngotracheomalacia. The study objective is to increase treatment and rehabilitation effectiveness in patients with laryngeal cancer after open laryngectomy. Materials and methods. Our experience is based on open laryngectomies in 86 patients performed at the Clinical Oncology Dispensary No. 1 of the Moscow Healthcare Department in the period from 2011 to 2014. Primary laryngeal cancer was diagnosed in 84 (97.7 %) patients, recurrent laryngeal cancer after a full course of radiation therapy – in 2 (2.3 %) patients. Vertical laryngectomy was performed in 74 patients, horizontal – in 12 patients. Vertical laryngectomies were performed for tumors located near the vocal and vestibular flaps, anterior commissure, subglottis, laryngeal sinus; horizontal for tumors located near the epiglottis, vestibular flaps, vallecula, root of the tongue if arytenoids were intact and vocal cords were mobile. In the postoperative period, an important factor was restoration of the organ’s function through early rehabilitation of respiratory, vocal, and protective functions. Evaluation of the laryngeal lumen was performed using endoscopic examination. Any diagnosed ligatures, granulation tissue, scars were resected. Prior to decannulation, ultrasound examination of the larynx was performed. Effectiveness of vocal function restoration was evaluated using computer acoustic analysis of the voice. Results. Restoration of the lost laryngeal functions after organ-preserving open laryngectomies in patients with laryngeal cancer is achieved through reconstruction of the remaining parts of the organ, formation of an adequate lumen for breathing through postoperative endoscopic correction, and early rehabilitation of respiratory, vocal, and protective function. Conclusion. Open laryngectomies with restoration of the remaining parts and single-step reconstruction of the lumen with an endoprosthesis, as well as subsequent combined treatment, allowed to restore respiratory function in 93.1 % patients, vocal function – in 91.9 % patients.

Totally Endoscopic Robotic Correction of Cor Triatriatum Sinister Coexisting with Atrial Septal Defect

Totally Endoscopic Robotic Correction of Cor Triatriatum Sinister Coexisting with Atrial Septal Defect

Modern approaches to treatment of vesicoureteral reflux in children

Vesicoureteral reflux (VUR) currently remains one of the significant problems of pediatric urology. The main goal of treatment is to prevent MTCT recrudescing flow pyelonephritis of the renal parenchyma damage, hypertension and CKD. Recent decades have seen significant changes in views on standards of treatment of children with VUR. Debated, today questions about the effectiveness of long-term antibiotic therapy and surgical correction method. Endoscopic reflux correction was first proposed in 1881 Matouschek E., as an alternative to conservative therapy and open surgery. The purpose of the study - assessment of the effectiveness and long-term results of endoscopic reflux correction of the first four degrees, and its place in the overall strategy of treatment of vesicoureteral reflux in children.

Comparison of results of endoscopic correction of vesicoureteral reflux in children using two bulking substances: Dextranomer/hyaluronic acid copolymer (Deflux) versus polyacrylate-polyalcohol copolymer (Vantris)

Endoscopic correction of vesicoureteral reflux (VUR) in children offers minimally invasive management and is widely used as a first-line procedure for all grades of reflux. However, there is debate about which tissue-augmenting substance is the best to use. The aim of this study was to evaluate the efficacy of two bulking substances, Deflux (Dx/HA) and Vantris (PPC), for endoscopic treatment of VUR in children. From 2009 to 2012, 65 children (50 girls and 15 boys) aged 1.45-9.9 years (mean 4.85±2.52) underwent endoscopic correction of VUR using Deflux. VUR was unilateral in 31 patients and bilateral in 34 patients, comprising 108 renal refluxing units (RRUs) grades: II in 52, III in 47, IV in 7, and V in 2. From 2012, 68 children (43 girls and 25 boys) aged 0.6-17.9 years (mean 4.89±3.46) were treated with Vantris. VUR was unilateral in 33 and bilateral in 35 patients, comprising 109 RRUs grades: II in 48, III in 29, IV in 13, and V in 19. Voiding cystourethrogram was done 3 months after procedure. All patients completed follow-up (summary Table). With Deflux, reflux resolved in almost 93% of RRUs after two procedures (in 63% after first injection), with Vantris, VUR was corrected in the same percentage after one procedure. The success rate with Deflux ranges between 68% and 92% (only 50-70% after single injection). The reported possibility of reflux recurrence after successful Deflux treatment, and the need for repeated injection led to introduction of the new substance Vantris. The results of a multi-centre survey published in 2014 showed that reflux is corrected in more than 90% of cases after single PPC injection. Our results with PPC confirm a high level of reflux resolution. Our data show that Vantris injection is a safe and effective procedure for treating all grades of VUR with good clinical outcome, and provides a higher and almost complete level of reflux resolution after first injection compared with Deflux.

MP55-07 HISTOPATHOLOGICAL CHANGES ASSOCIATED WITH POLYACRYLATE POLYALCOHOL BULKING COPOLYMER (PPC, VANTRIS) INJECTION FOR PAEDIATRIC VESICOURETERAL REFLUX (VUR)

You have accessJournal of UrologyPediatrics: Urinary Tract Infection and Vesicoureteral Reflux1 Apr 2016MP55-07 HISTOPATHOLOGICAL CHANGES ASSOCIATED WITH POLYACRYLATE POLYALCOHOL BULKING COPOLYMER (PPC, VANTRIS) INJECTION FOR PAEDIATRIC VESICOURETERAL REFLUX (VUR) Boris Chertin, Stanislav Kocherov, Ermelinda Mele, Simona Gerocarni Nappo, and Nicola Capozza Boris ChertinBoris Chertin More articles by this author , Stanislav KocherovStanislav Kocherov More articles by this author , Ermelinda MeleErmelinda Mele More articles by this author , Simona Gerocarni NappoSimona Gerocarni Nappo More articles by this author , and Nicola CapozzaNicola Capozza More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.598AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Endoscopic correction of VUR utilizing Vantris has demonstrated high efficacy not only during a short term period, but also during a long term follow up without VUR recurrence. We have hypothesized that the obstruction following endoscopic correction of VUR is related to the anatomical features of the UVJ rather than the type of material used for endoscopic correction. Therefore, we have retrospectively evaluated all cases of obstruction following endoscopic treatment of VUR in both departments over the last 5 years and have performed clinical and histological review of these patients. METHODS Study population comprised 2470 patients who underwent endoscopic correction of VUR utilizing Deflux (1790 children) and Vantris (680 patients). 9(0.5%) children (3 F and 6 M) in Deflux group and 8(1.2%) (4 F and 4 M) in Vantris group developed UVJ obstruction and required ureteral re-implantation. Tissue sections were stained with hematoxylin eosin and trichrome and examined under a light microscope. Nine primary obstructive megaureters after ureteral re-implantation served as controls. RESULTS All children developed obstruction during the period ranging from 2 to 49 months (average 16 months) following endoscopic correction. The primary reflux grade was III in 7, IV in 6 and V in 4 children respectively. The review of pretreatment VCUG demonstrated the presence of refluxing/obstructive ureter in 10(58.8%) out of 17 obstructive ureters showing true obstruction in 7 ureters (1 from Deflux and 6 from Vantris group). Histopathological analysis revealed a pseudocapsule composed of fibrous tissue and foreign body-type giant cells surrounding the Vantris implant in all patients. The distal part of the ureters demonstrated significant ureteral dilatation without ureteral fibrosis. In all patients, additional biopsies from the muscularis propria adjacent to the injection site were examined and showed no significant abnormalities. There was an increased collagen deposition in the juxtavesical segment of the obstructive ureters following Deflux, Vantris injection and also of primary obstructive megaureter. No significant difference was found in the tissue response between Deflux, Vantris patients and controls. CONCLUSIONS Our data show that Vantris injection does not lead to ureteral fibrosis or inflammatory changes and therefore does not seem to increase the incidence of UVJ obstruction. However, patients with high grade VUR and an initial underlying ureteral pathology should receive appropriate counseling upon surgery concerning the possibility of UVJ obstruction and the need in subsequent ureteral re-implantation. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e738 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Boris Chertin More articles by this author Stanislav Kocherov More articles by this author Ermelinda Mele More articles by this author Simona Gerocarni Nappo More articles by this author Nicola Capozza More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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

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.

Nine Year Retrospective Review of Surgical Treatment of Vesicoureteral Reflux: Comparison of Three Approaches

Objective: To analyze our nine-year experience in the surgical management of vesicoureteral reflux (VUR) with open ureteral reimplantation, robotic reimplantation, and endoscopic correction with Deflux. Methods: We retrospectively reviewed all patients undergoing surgical intervention for primary VUR at our institution between 2001 and 2010. Treatment success was defined as complete resolution of VUR on postoperative voiding cystourethrography. Surgeries were performed by four pediatric urologists. All robotic reimplantations were performed by a single surgeon. Categorical comparisons were made using Pearson’s Chi-Square or Fisher’s Exact test, and continuous variables were compared using Mann-Whitney U. Results: One hundred eighty-three patients (287 ureters) were included. Fourteen patients underwent robotic surgery, while the open surgery and Deflux cohorts included 93 and 76 patients, respectively. Due to the significantly smaller sample size of the robotic cohort, statistical comparisons were made only between the open surgery and Deflux cohorts. Postoperative VUR resolution rate was 100% (open), 85% (robotic), and 78.4% (Deflux). Open reimplantation had a significantly higher VUR resolution rate than Deflux (p<0.001). Overall, 13.9% of patients developed contralateral reflux, with no significant differences between the open and Deflux cohorts. Conclusions: In this study, we found significantly higher success rates with open reimplantation versus Deflux. While robotic reimplantation had high success rates and short hospital stays, the smaller sample size limited statistical comparison of this modality to open surgery or Deflux. We continue to enroll patients into a prospective series of all VUR procedures at our institution, which will result in more robust comparisons.

Vesicoureteral reflux and its complications in children in relation to the degree of connective tissue dysplasia

The paper deals with an association of connective tissue dysplasia with vesicoureteral reflux and its complications in children. Highgrade vesicoureteral reflux was found to be typical of children with severe connective tissue dysplasia; moreover, its repeated endoscopic correction is required in 27% of cases. The frequency of vesicoureteral reflux complications as hypertension and focal nephrosclerosis did not depend on the degree of connective tissue dysplasia. Urinary tract abnormalities were more specific to children with severe connective tissue dysplasia. The children, mainly girls, with severe connective tissue dysplasia showed a propensity to have recurrent urinary tract infection.

Endoscopic treatment of intestinal malrotation in newborns and infants

To compare treatment of intestinal malrotation in newborns and infants using laparoscopy and laparotomy. For the period from January 2004 to December 2013 34 Ladd's procedures were performed. Children were divided into 2 groups by 17 patients: laparoscopic (group I) and open treatment (group II). Both groups had similar demographic and other preoperative parameters. There were significant differences in duration of operation between both groups (61 vs. 70 minutes). Nutrition was initiated earlier after mini-invasive treatment (1.5 days vs. 3 days) and the time need for full enteral nutrition was also less (4.2 days vs. 6.9 days). Hospital-stay was shorter in group I (7.7 vs. 10.2 days). Number of early postoperative complications was similar in groups. Incidence of remote complications was higher in laparotomy group but the differences were not significant. Our results showed that endoscopic correction of congenital anomalies of intestinal rotation provides better postoperative results than open surgery and can be widely used in young children.