Is routine voiding cystourethrogram necessary following double hit for primary vesicoureteral reflux?

Area of Science:

• Pediatric Urology
• Minimally Invasive Surgery

Background:

• Current guidelines recommend voiding cystourethrogram (VCUG) after endoscopic treatment for vesicoureteral reflux (VUR).
• The Double HIT (hydrodistention implantation technique) is an endoscopic procedure for primary VUR.

Purpose of the Study:

• To evaluate the clinical and radiographic outcomes of Double HIT for primary VUR.
• To determine the success rates of Double HIT.
• To assess the necessity of routine postoperative VCUG.

Main Methods:

• Retrospective analysis of children undergoing Double HIT for primary VUR (2009-2012).
• Patients were classified as high or low clinical/radiographic risk.
• Comparison of outcomes between a 'routine' VCUG group and an 'indicated' VCUG group.

Main Results:

• High overall clinical success rate (93.7%) following Double HIT.
• Children in the 'indicated' VCUG group were more likely to experience radiographic failure (13x odds).
• Low incidence of postoperative febrile urinary tract infection (fUTI).

Conclusions:

• Double HIT demonstrates high long-term clinical success for primary VUR.
• Selective postoperative VCUG, based on specific indications, may be prudent.
• Routine VCUG may not be necessary for all children undergoing Double HIT for VUR.