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Is endoscopic injection therapy a reasonable treatment option for low-grade vesicoureteral reflux in association with
Kate H Kraft1, Joseph A Molitierno, Liisa Dewhurst
1Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia 30342, USA.
Insights
Endoscopic injection effectively treats vesicoureteral reflux (VUR) in children with overactive bladder (OAB). Many patients experienced improved bladder function post-treatment, with some no longer needing OAB therapy.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Pediatric Nephrology
Background:
- Vesicoureteral reflux (VUR) is a common condition in children, often associated with overactive bladder (OAB).
- Endoscopic injection is a minimally invasive treatment option for VUR.
- The efficacy of endoscopic injection in children with concomitant OAB requires further investigation.
Purpose of the Study:
- To evaluate the clinical outcomes of endoscopic injection for VUR in pediatric patients with OAB.
- To assess the impact of OAB control on treatment success rates.
- To determine if VUR resolution influences OAB management.
Main Methods:
- A cohort of 41 children with VUR and OAB underwent endoscopic injection of dextranomer/hyaluronic acid.
- Patients were categorized based on OAB control (well-controlled vs. persistent OAB).
- Postoperative voiding cystourethrogram and clinical follow-up (1-5 years) were performed to assess treatment success.
Main Results:
- A high success rate of 82.9% was observed after a single endoscopic injection treatment.
- Radiographic success was achieved in 76.9% of well-controlled OAB patients and 85.7% of persistent OAB patients.
- Overall clinical success (no UTI with negative VCUG) was 78.0%, with 40% of well-controlled OAB patients no longer requiring OAB therapy post-VUR resolution.
Conclusions:
- Endoscopic injection is a viable and effective treatment for VUR in children with OAB.
- Treatment outcomes are comparable to those without OAB, regardless of OAB control status.
- Resolution of VUR may lead to spontaneous improvement or resolution of OAB symptoms in a significant proportion of pediatric patients.
Objective:
To assess the clinical outcome of endoscopic injection in children with vesicoureteral reflux (VUR) and concomittant overactive bladder (OAB).
Methods:
A total of 41 patients with VUR and OAB underwent endoscopic injection of dextranomer/hyaluronic acid. At surgery, 13 patients had been successfully treated for their OAB (urgency with or without wetting) with behavior modification with or without anticholinergic therapy, and 28 had persistent OAB despite treatment. Voiding cystourethrogram was obtained 6-12 weeks postoperatively, and patients were followed up clinically for 1-5 years.
Results:
Negative voiding cystourethrogram findings after a single treatment were seen in 34 (82.9%) of 41 patients. The radiographic success rate in patients with well-controlled OAB was 76.9% (10 of 13) compared with 85.7% (24 of 28) of those with poorly controlled OAB. The overall clinical success rate, defined as no evidence of urinary tract infection in the setting of negative voiding cystourethrogram findings, reached 78.0% (32 of 41). After successful endoscopic treatment, an unanticipated return to normal voiding patterns without the need for postoperative anticholinergic therapy was seen in 4 of the children with well-controlled OAB (40.0%) and in 4 with poorly controlled OAB (16.7%).
Conclusion:
Our data suggest that endoscopic injection is a viable treatment option for VUR in those with OAB, with postoperative rates of resolution comparable to those found in patients without OAB. Furthermore, 40.0% of children with well-controlled OAB no longer required therapy for OAB after resolution of their VUR.
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