Vesicoureteral Reflux In Adults Research Articles

Surgical management of vesicoureteral reflux in adults

Vesicoureteral reflux (VUR) is the retrograde flow of urine from the bladder into the upper urinary tract with or without upper-tract dilatation. This diagnosis is commonly made in childhood, affecting 1% of all births. In adults, its prevalence and incidence are not known. Presentation in adults could be with loin pain associated with voiding or a full bladder, recurrent urinary tract infections, a diagnosis carried over from childhood or an incidental finding. Most of the works on VUR have been done in the paediatric population. There are limited publications addressing VUR in adults. Unsurprisingly, the management of VUR in adults is extrapolated from the knowledge that we have gained from paediatric urology. Herein, we recap on the pathophysiology and review the surgical management of VUR in adults as published over the years.

Vesicoureteral Reflux in Adults with Urinary Tract Infections: Is There a Role for Treatment?

Urinary tract infections (UTI) place a significant burden on individual patients and the healthcare system as a whole. Vesicoureteral reflux (VUR) is a risk factor for UTIs and is the focus of much research in the pediatric field due to the opportunity for early intervention and prevention of long-term sequelae. However, VUR in the adult population is not well studied and can present different treatment challenges. The goal of this review article is to discuss the role VUR plays in UTIs in the adult population with a specific focus on complications and treatment. The true prevalence of VUR in the adult population remains unknown, and urologists need to maintain an index of suspicion for VUR when evaluating adult patients with recurrent pyelonephritis or complicated UTIs. A number of case series and smaller retrospective studies have documented successful endoscopic treatment of adult VUR patients with recurrent pyelonephritis. Ureteral reimplantation remains an option for adult patients who are refractory to endoscopic treatment of VUR. The current treatments and recommendations for VUR in adults have been extrapolated from the pediatric population due to the scarcity of research. VUR is uncommon in the adult population and requires a high index of suspicion by the clinician. Accurate diagnosis and treatment of VUR can relieve patients from recurrent infections, repetitive antibiotic use, and the risk of hospitalization.

Treatment of Vesicoureteral Reflux in Adults by Endoscopic Injection

To prospectively evaluate the efficacy of endoscopic injection in the adult population with vesicoureteral reflux (VUR). The search for VUR is a part of the standard workup of children with febrile urinary tract infections. However, VUR can present later in life and should be investigated in the case of recurrent pyelonephritis. From 2005 to 2009, 27 postpubertal patients (3 males and 24 females) were treated endoscopically with injection of polydimethylsiloxane (Macroplastique) in 13 or dextranomer/hyaluronic acid copolymer (Deflux) in 14 patients; 41 renal units were injected. The median age was 23 years (range 12-65). The VUR was evaluated as grade I in 5 ureters, grade II in 28, grade III in 7, and grade IV in 1. The indications for surgery were recurrent pyelonephritis in all patients, except for 1. Of the 27 patients, 5 (12%) had undergone previous ureteral surgery. The patients were followed up with renal ultrasonography and voiding cystourethrography. VUR was corrected in 38 (93%) of 41 ureteral units. Of the 3 failures, 1 patient had a large Hutch diverticulum and another had previously undergone ureterocele incision. All the patients with treatment failure had been injected with dextranomer/hyaluronic acid copolymer. Thus, the success rate was 100% with polydimethylsiloxane and 87% with dextranomer/hyaluronic acid copolymer. De novo hydronephrosis appeared in 1 renal unit. The obstruction was confirmed by a mercaptoacetyltriglycine-Lasix technetium-99m scan and treated with temporary diversion using a double-J stent. Endoscopic injection is an effective treatment of VUR after puberty. In cases of recurrent pyelonephritis, imaging should be mandatory to detect scars and VUR because the endoscopic treatment is simple and noninvasive and has a good success rate, comparable to that reported for children.

Efficacy of endoscopic subureteral injection for vesicoureteral reflux in adults with decreased bladder compliance

To evaluate the outcome of endoscopic subureteral injection (ESI) in adults with vesicoureteral reflux (VUR) associated with decreased bladder compliance (D-BC). We retrospectively reviewed the medical records of 46 consecutive patients who underwent ESI for VUR at a single tertiary academic center. Fourteen patients (17 ureter units) who had underlying neurological disease with decreased bladder compliance, as determined by filling cystometry, were grouped as D-BC. Thirty-two patients (47 units) who had no signs or symptoms that suggested neurogenic lower urinary tract dysfunctions were grouped as normal bladder compliance (N-BC). We compared the cure rates for ESI between groups, defining cure as complete resolution of reflux on voiding cystourethrogram. In 70.6% of the D-BC group and 70.2% of the N-BC group, VUR resolved completely after the first injection (P = 0.977). One failed unit of D-BC was cured after second ESI, and seven failed units of N-BC were cured after additional treatments (second ESI, two patients; ureteroneocystostomy, five patients). No additional treatments were applied to three units of D-BC or seven units of N-BC without symptoms. No complications related to the ESI were observed. The ESI was found to be effective in adults with VUR regardless of the bladder compliance. As a minimally invasive procedure with a favorable outcome, ESI may represent the first choice for treatment of VUR even in adults with D-BC.

Editorial Comment to Efficacy of endoscopic subureteral injection for vesicoureteral reflux in adults with decreased bladder compliance

Editorial Comment to Efficacy of endoscopic subureteral injection for vesicoureteral reflux in adults with decreased bladder compliance

Endoscopic treatment of vesicoureteral reflux in an adult population: Can we teach our adult urology colleagues?

Vesicoureteral reflux (VUR) is not well described or understood in adults. Since endoscopic correction of VUR has become a first-line therapy in children, we aimed to evaluate the efficacy of this technique in adult patients. In 1988-2008, 49 adult patients (6 males, 43 females) with a mean age of 33.6 years (range 18-64) underwent endoscopic treatment of VUR. Reflux was unilateral in 17 (34.7%) and bilateral in 32 (65.3%) patients, comprising 81 renal refluxing units (RRU). Of these, 71 (87.7%) were primary VUR. Reflux was Grade I in 14 (17%), Grade II in 46 (56.8%), Grade III in 17 (21%) and Grade IV in 4 (4.9%) RRU. Median renal function at surgery was 41.2%. Endoscopic correction utilized polytetrafluoroethylene (Teflon) in 38 (77.6%) and dextranomer/hyaluronic acid copolymer in 11 (22.4%) patients. Recurrent febrile urinary tract infection (UTI) was the only indication for surgery. Grade I VUR was treated only in patients with contralateral high-grade VUR. The reflux was corrected in 63 (77.8%) RRU after a single injection, after second injection in 9 (10.6%) and after third in 4 (4.8%) RRU. In 3 (3.5%) RRU, VUR improved to Grade I. In 2 (2.4%), endoscopic correction failed, leading to open reimplantation. One patient with corrected VUR underwent nephrectomy due to non-functioning kidney and recurrent pyelonephritis. Fourteen (28.6%) patients suffered afebrile UTI. Five (10.2%) developed febrile UTI following successful endoscopic correction, leading to a diagnosis of VUR recurrence in two (4.1%) patients. Endoscopic correction of VUR in adults is a simple and effective procedure, as in pediatric practice.

Traitement endoscopique du reflux vésico-urétéral par implant de polydiméthylsiloxane (Macroplastique™) : revue de la littérature

During the last 25years, endoscopic correction of vesicoureteral reflux (VUR) has become a well-recognized procedure. However, the nature of the bulking agent used has led to many controversies. The objective of this work was to perform a literature review on the use of polydimethylsiloxane (PDMS or Macroplastique) in VUR. A PubMed review of the literature since 1996 resulted in the selection of 24 studies of sufficient level of evidence to assess the efficacy and tolerance of Macroplastique in the VUR in adults and children. The overall success rate at 1 year, 2 years and 9-years follow-up was respectively 86-93 %, 80-92 %, and 77-100 %, which confirms the maintenance of good results over time, notably in VUR grade III and above. The success rate was similar for primary and secondary VUR except for total duplicity. Predictive criterias of success were the surgeon's experience, the low grade of VUR, and the absence of previous injection. In comparison with other bulking agents, the higher viscosity and absence of shrinkage of the product increase its reliability. After more than 12years of use, no serious complication has been reported in the literature, reflecting the good tolerance of Macroplastique on the long term. The studies published on the use of Macroplastique in VUR confirmed its efficacy, around 85 % of success for all grades, in children and adults as well. The interest of PDMS is linked to its higher viscosity promoting a better reliability and reproducibility of the technique and its non-resorbable nature providing a permanent result, especially valuable in high-grade VUR with anatomical anomaly of the vesicoureteral junction or in VUR secondary to permanent lower urinary tract dysfunction.

Vesicoureteral Reflux in Adults Studied by Computerized Radionuclide Cystography

Direct radionuclide cystography in a computerized method as described by Willi and Treves was used in adults with recurrent pyelites but without evidence of obstruction. Reflux was observed in 15 out of 38 patients. In patients with neurogenic bladder dysfunction or megaureters, reflux began early during the bladder filling and attained higher volumes than in those with uncomplicated pyelitis, who had minor reflux appearing mainly during voiding. Bladder capacity and detrusor compliance were lower in patients with reflux than In those without reflux. The low radiation exposure In radionuclide cystography permits observation of the urodynamic course of urinary reflux and correlation to the intravesical volume and pressure. The method is sensitive, and minorl refluxed volumes can be detected. Radionuclide cystography can therefore be recommended for checking of surgical results and for follow-up of patients with neurogenic bladder dysfunction.

A Plea for Antireflux Operations in Adults: Review of 50 Cases

The results of antireflux operations in 41 cases of primary and 9 cases of secondary vesicoureteral reflux in adults are presented. Reflux was eliminated in all cases and there were no postoperative complications. Most patients had a long history of urinary tract infection preoperatively, which was eliminated in 64.1 per cent of the cases after surgical correction of the reflux. A relapse of infection occurred in 30.8 per cent of these cases. Chronic pyelonephritis remains active in 5.1 per cent of the cases. There were 6 patients with serum creatinine levels higher than 1.8mg. per cent who underwent a successful antireflux procedure without an increase of serum creatinine levels. An antireflux operation should be preferred over long-term conservative management in most cases of symptomatic vesicoureteral reflux in adults less than 50 years old.

Non-Obstructive Vesicoureteral Reflux in Adults: Value of Conservative Treatment

Chronic or recurrent non-obstructive urinary tract infection was investigated in 158 adult patients, 39 of whom had vesicoureteral reflux. Conservative, long-term chemotherapy did not eradicate the reflux in these patients. The characteristics of reflux in adults were studied with cystograms, excretory urograms, cystoscopic findings of the ureteral orifices or trigones and the clinical histories of the patients. These data were evaluated and compared to data obtained from adults with chronic or recurrent uncomplicated urinary tract infection and from children with vesicoureteral reflux who were referred to us during the same period.Non-obstructive vesicoureteral reflux in adults may be considered to be congenital in most cases, since the proportion of trigonal anomalies in adults with reflux is equal to that in children and the frequency of abnormalities at the ureteral orifice and trigonal region is significantly more than the frequency noted in control patients with uncomplicated pyelonephritis. Characteristically, excretory urography revealed caliceal scarring in adults with reflux in contrast to children, in whom a normal or dilated pattern of the upper tract was prominent. Recurring renal infection, for which this congenital defect of the ureterovesical valve must be responsible, produces progressive renal damage. Prolonged conservative treatment is of little use and is often destructive in adults with reflux.

Active surgical management of primary vesicoureteral reflux in adults.

Of 27 adults with primary vesicoureteral reflux, 23 were treated surgically. These patients had suffered from chronic urinary-tract infections with poor response to conservative therapy. Urography revealed inflammatory changes in one or both kidneys in 18 patients, as well as other renal or ureteral deformities. Micturition cystography showed reflux reaching the renal pelvis and dilatation of the pelvis and ureter in 18 patients (28 ureters). An antireflux operation was performed on 32 ureters and in all cases was followed by disappearance of the reflux. No ureteral stricture developed postoperatively. During an observation period averaging more than three years only three patients had postoperative urinary-tract infections. These occurred when a short period of medication was terminated. On the basis of present experience we consider that antireflux surgery is indicated for all adults with vesicoureteral reflux and urinary-tract infections or progressive dilatation of the upper urinary tract.

Vesicoureteral reflux in adults: A twelve-year study of 122 patients

In a twelve-year study, 122 adults with vesicoureteral reflux were followed for at least one year. Reflux ceased in 21 per cent of those managed medically, in 27 per cent of those treated by a combination of drugs and surgical procedures other than antireflux techniques, and in 95 per cent of those treated by an antireflux procedure. Pyelonephritis occurred or worsened in 14 per cent of the medically treated patients and in none treated by an antireflux procedure. Two patients managed medically died of uremia from chronic pyelonephritis. No patients died after an antireflux operation.

Vesicoureteral Reflux in Children: A Computerized Review

Vesicoureteral Reflux in Children: A Computerized Review

Experience with Ureteral Reimplantation in the Treatment of Recurring Urinary Infections in Childhood

No AccessJournal of UrologyPediatric Urology1 Apr 1970Experience with Ureteral Reimplantation in the Treatment of Recurring Urinary Infections in Childhood Stuart E. Price, S. Harris Johnson, and Matthew Marshall Stuart E. PriceStuart E. Price More articles by this author , S. Harris JohnsonS. Harris Johnson More articles by this author , and Matthew MarshallMatthew Marshall More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)61989-XAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1970 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byBisignani G and Decter R (2018) Voiding Cystourethrography After Uncomplicated Ureteral Reimplantation in Children: Is It Necessary?Journal of Urology, VOL. 158, NO. 3, (1229-1231), Online publication date: 1-Sep-1997.Ahmed S (2018) Revision of Ureteral Reimplantation by the Transverse Advancement TechniqueJournal of Urology, VOL. 122, NO. 4, (550-553), Online publication date: 1-Oct-1979.Senoh K, Iwatsubo E and Momose S (2018) Followup Study After Conservative and Surgical Treatment of Vesicoureteral RefluxJournal of Urology, VOL. 119, NO. 2, (199-201), Online publication date: 1-Feb-1978.Ahmed S (2018) Ureteral Reimplantation by the Transverse Advancement TechniqueJournal of Urology, VOL. 119, NO. 4, (547-550), Online publication date: 1-Apr-1978.Senoh K, Iwatsubo E, Momose S, Goto M and Kodama H (2018) Non-Obstructive Vesicoureteral Reflux in Adults: Value of Conservative TreatmentJournal of Urology, VOL. 117, NO. 5, (566-570), Online publication date: 1-May-1977.Gonzales E, Glenn J and Anderson E (2018) Results of Distal Tunnel Ureteral ReimplantationJournal of Urology, VOL. 107, NO. 4, (572-575), Online publication date: 1-Apr-1972. Volume 103Issue 4April 1970Page: 485-490 Advertisement Copyright & Permissions© 1970 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Stuart E. Price More articles by this author S. Harris Johnson More articles by this author Matthew Marshall More articles by this author Expand All Advertisement PDF downloadLoading ...

The Anatomical Basis and Dynamics of Vesicoureteral Reflux

The Anatomical Basis and Dynamics of Vesicoureteral Reflux