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Avoiding routine postoperative voiding cystourethrogram: Predicting radiologic success for endoscopically treated

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Area of Science:

  • Pediatric Urology
  • Minimally Invasive Surgery
  • Diagnostic Imaging

Background:

  • Endoscopic correction of vesicoureteral reflux (VUR) shows variable success rates.
  • Routine postoperative voiding cystourethrogram (VCUG) use is debated.
  • Predictive factors for VUR resolution after endoscopic treatment require investigation.

Purpose of the Study:

  • To evaluate intraoperative mound morphology (IMM) and postoperative ultrasound mound (PUM) for predicting radiologic success in VUR endoscopic correction.
  • To assess the utility of a combined IMM and PUM prediction model.
  • To determine if PUM alone can guide selective postoperative VCUG use.

Main Methods:

  • Retrospective study of 70 children undergoing endoscopic VUR correction with dextranomer/hyaluronic acid.
  • Intraoperative assessment of IMM.
  • Postoperative ultrasound for PUM and VCUG for VUR resolution assessment.

Main Results:

  • Overall radiologic success rate was 83.5%.
  • IMM showed no significant association with radiologic success (p=0.81).
  • PUM demonstrated high sensitivity (98%) and moderate specificity (71%) for radiologic success. The combined model had lower sensitivity (81.9%) and specificity (85.7%) than PUM alone.

Conclusions:

  • IMM is an unreliable predictor of radiologic success in endoscopic VUR treatment.
  • A combined prediction model of IMM and PUM is less effective than PUM alone.
  • Postoperative VCUG can be selectively used based solely on the presence of a PUM.