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Published on: January 7, 2019
Bladder Dysfunction and Re-Absorbable Bulking Agent Affect Success Rate in Children Underwent Endoscopic Treatment
Raffaella Cocomazzi1, Alessia Salatto1, Vittoria Campanella1
1Pediatric Surgery Unit, Department of Clinic and Surgical Science, University of Foggia, 71122 Foggia, Italy.
Insights
Endoscopic treatment for dilating vesicoureteral reflux (VUR) shows long-term effectiveness. Bladder dysfunction significantly increases VUR recurrence risk, regardless of reflux grade or laterality.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
Background:
- Dilating vesicoureteral reflux (VUR) is a common condition in children.
- Endoscopic treatment (ET) is a minimally invasive option for VUR management.
- Long-term outcomes of ET, particularly factors influencing recurrence, require further investigation.
Purpose of the Study:
- To evaluate the long-term efficacy of endoscopic treatment for dilating VUR in children.
- To identify factors affecting VUR resolution and recurrence after ET.
- To assess the impact of VUR grade, laterality, bladder dysfunction, duplex systems, and bulking agents on long-term outcomes.
Main Methods:
- Retrospective chart review of 93 children with dilating VUR undergoing ET.
- Minimum 7-year post-operative follow-up (mean 9.6 years).
- Analysis of VUR grade, laterality, bladder dysfunction, duplex systems, and bulking agents (polydimetilsiloxane or hyaluronic acid/dextranomer).
Main Results:
- VUR persistence was independent of VUR grade, laterality, duplex systems, and bladder dysfunction.
- However, VUR recurrence rate was significantly higher in children with bladder dysfunction.
- Children treated with hyaluronic acid/dextranomer experienced a higher VUR persistence rate.
Conclusions:
- Endoscopic treatment for VUR is effective and safe at very long-term follow-up.
- Bladder dysfunction is the primary preoperative predictor of VUR recurrence.
- Absorbable bulking agents may be associated with a higher long-term recurrence rate.
Abstract:
This paper is designed to evaluate the results (at long-term follow-up of) children affected by dilating VUR. Our attention was focused on how VUR grade, laterality, bladder dysfunction (BD), the double renal system, and the type of bulking substance may affect VUR resolution in the long-term period. The charts of 93 children with dilating VUR who underwent endoscopic treatment (ET) and with a minimum post-operative follow-up of 7 years were reviewed (mean follow-up time was 9.6 + 1.4). The majority of patients had severe and bilateral VUR. Polydimetilsiloxane or hyaluronic acid/dextranomer (PDS or Ha/Dx) were used as bulking agents. VUR persistence following endoscopic injection was independent with respect to grade, laterality, duplex renal system, and BD. However, the rate of VUR persistence was significantly higher in children with BD. Children treated with Ha/Dx had a higher rate of VUR persistence. This research demonstrated that ET of VUR is also effective at very long term follow up (and without the development of significant complications). We also showed that patients treated with absorbable bulking agents such as Ha/Dx may experience a higher recurrence rate at the long-term follow-up). We also confirm that the only preoperative condition affecting VUR recurrence was bladder dysfunction.
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