You have accessJournal of UrologyPediatrics: Urinary Tract Infection & Vesicoureteral Relux1 Apr 2014MP44-13 TEMPORAL PATTERN OF VESICOURETERAL REFLUX ON VOIDING CYSTOURETHROGRAM CORRELATES WITH ENDOSCOPIC HYDRODISTENTION GRADE OF URETERAL ORIFICE Angela M. Arlen, Kristin M. Broderick, Kathy H. Huen, Traci Leong, Hal C. Scherz, and Andrew J. Kirsch Angela M. ArlenAngela M. Arlen More articles by this author , Kristin M. BroderickKristin M. Broderick More articles by this author , Kathy H. HuenKathy H. Huen More articles by this author , Traci LeongTraci Leong More articles by this author , Hal C. ScherzHal C. Scherz More articles by this author , and Andrew J. KirschAndrew J. Kirsch More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1388AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives The Double HIT (hydrodistention implantation technique) for VUR treatment utilizes dynamic hydrodistention (HD) of the distal ureter and orifice to visualize the injection site and determine appropriate bulking agent volume. Correlation with VUR grade has been documented. Along with grade, timing of VUR provides prognostic information regarding spontaneous resolution. We compared endoscopic HD grade and timing of reflux on VCUG in patients with primary VUR. Methods Between January 1, 2009 and December 31, 2012, 196 children undergoing Double HIT were identified. HD grading included H0 – no hydrodistention, H1 – ureteral orifice open but tunnel not evident, H2 – intramural tunnel visualized and H3 – extravesical ureter visualized. VUR timing on VCUG assigned according to 1 – early to mid-filling, 2 – late filling and 3 – voiding. HD grade was compared to grade and timing of VUR. Children with secondary VUR, prior VUR surgery or aberrant anatomy were excluded. Results One hundred and ninety-six children age 3.94 ± 2.58 years underwent injection of 332 ureters with a mean of 1.81 preoperative VCUGs. Mean VUR grade was 2.8 ± 0.9 with the following breakdown: grade 1 (26), grade 2 (86), grade 3 (149), grade 4 (65) and grade 5 (6). 52.4% of ureters showed early to mid-filling, 39.2% late filling and 8.4% had voiding-only VUR. VUR timing was dependent upon grade with lower VUR grades detected later in the bladder cycle. Mean VUR grade for early reflux was 3.1 ± 0.81 vs. 2.6 ± 0.81 for late filling vs. 2.1 ± 1.1 for voiding (p<0.0001). VUR and HD grades correlated; higher VUR grades were associated with H3 ureters (p<0.001). There was a significant relationship between VUR timing and HD grade, with H3 ureters experiencing early VUR more frequently than H1-2 ureters (p<0.0001) [Figure]. Injected volume also correlated with HD grade. Mean volume with H3 ureters (1.6 mL) was significantly higher than H1-2 ureters (1.25 mL, p<0.001). Conclusions Degree of dynamic ureteral HD correlates with VUR grade, timing of reflux and injected bulking agent volume. VUR during early to mid-filling, which has been shown to have lower rates of spontaneous resolution, is associated with abnormal hydrodistention further validating the HD classification system. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e447-e448 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Angela M. Arlen More articles by this author Kristin M. Broderick More articles by this author Kathy H. Huen More articles by this author Traci Leong More articles by this author Hal C. Scherz More articles by this author Andrew J. Kirsch More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...