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High-grade vesicoureteral reflux in infants: Our experience with endoscopic subureteric injections
Saeed Al Hindi1, Mohamed Mubarak1, Husain Al Aradi1
1Department Surgery, Salmaniya Medical Complex, Manama, Kingdom of Bahrain.
Insights
Endoscopic injection of Dextranomer/Hyaluronic Acid Copolymer (Deflux) effectively treats high-grade vesicoureteral reflux (VUR) in infants. This minimally invasive approach resolves VUR in 90% of cases, avoiding open surgery.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Urological Anomalies
Background:
- Vesicoureteral reflux (VUR) is the most common pediatric urological anomaly.
- Management options include continuous antibiotic prophylaxis (CAP), endoscopic injection, and open surgery.
- This study evaluates Dextranomer/Hyaluronic Acid Copolymer (Deflux) for primary high-grade VUR in infants.
Purpose of the Study:
- To assess the efficacy of endoscopic subureteric injection of Deflux in managing primary high-grade VUR in infants.
- To determine the success rate of Deflux in resolving VUR in pediatric patients.
- To evaluate Deflux as a minimally invasive alternative to open surgery for VUR.
Main Methods:
- Prospective observational study of infants under 1-year-old with primary high-grade VUR (2010-2015).
- Diagnosis confirmed by voiding cystourethrography (VCUG).
- Patients received endoscopic subureteric injections of Deflux, with pre- and post-intervention assessments.
Main Results:
- 30 infants (50 renal units) with high-grade VUR (grades IV-V) were included.
- 90% of patients achieved complete symptomatic relief post-operatively.
- 90% success rate with one or two Deflux injections; no patients required open surgery.
Conclusions:
- Endoscopic Deflux injection is an effective, minimally invasive treatment for high-grade VUR (IV-V) in infants.
- Deflux offers a successful alternative to open surgery for pediatric VUR.
- This technique provides a high success rate for resolving VUR in young children.
Background:
Vesicoureteral reflux (VUR) is the most common urological anomaly in pediatric patients. Management options for VUR vary from continuous antibiotic prophylaxis (CAP) to surgery via either endoscopic subureteric injection of a bulking agent or open anti-reflux surgery. In this study, we assess the efficacy of subureteric injections of Dextranomer/Hyaluronic acid Copolymer (Deflux) in managing primary VUR in infant patients with high-grade VUR.
Methods:
From 2010 to 2015, children less than 1-year-old with primary high-grade VUR were observed prospectively following the administration of endoscopic subureteric injections of Dextranomer/Hyaluronic Acid Copolymer (Deflux). The diagnosis of VUR was based on MCUG, and all patients underwent a holistic clinical, laboratory, and radiological assessment before and after the intervention. Complete success was defined as the resolution of VUR on follow up 1 year post-operatively.
Results:
A total of 30 infants (50 renal units) with high-grade VUR (grades IV and V) were included in the study. The mean age at surgery was 6.3 ± 2.5 months. Most of the patients presented with a urinary tract infection (90%). Complete symptomatic relief was achieved in 27 patients (90%) at the first post-operative follow-up. Forty-four renal units received one injection, while six required a second injection as they did not meet our treatment success criteria. No patients required a third injection or referral for open surgery.
Conclusion:
Endoscopic injection of Dextranomer/Hyaluronic acid Copolymer (Deflux) at the vesicoureteral junction is an effective minimally invasive intervention to treat high grades VUR (IV-V) infants.
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