Urodynamic changes after endoscopic correction of vesicoureteral reflux

Area of Science:

• Pediatric Urology
• Minimally Invasive Surgery
• Nephrology

Background:

• Massive bilateral vesicoureteral reflux (VUR) presents significant challenges in pediatric patients, often associated with urinary tract infections (UTIs) and incontinence.
• Spinal scoliosis can coexist with VUR, potentially complicating diagnosis and management.
• Assessing bladder function is crucial for effective treatment planning in pediatric reflux cases.

Observation:

• A 7-year-old girl with spinal scoliosis presented with febrile UTIs and urinary incontinence.
• Initial cystometrogram revealed normal detrusor function during bladder filling.
• Endoscopic subureteric injection of polytetrafluoroethylene (Teflon) effectively corrected the bilateral VUR.

Findings:

• Postoperative cystometrogram indicated the emergence of detrusor overactivity during bladder storage, requiring anticholinergic medication.
• The patient remained free of febrile UTIs and incontinence for two years following the endoscopic procedure.
• Self-catheterization became necessary post-operatively.

Implications:

• Endoscopic subureteric injection serves as a valuable therapeutic option for massive VUR in children.
• This technique can also diagnose occult detrusor overactivity, aiding in surgical planning for neurogenic bladder dysfunction.
• Minimally invasive VUR correction offers a successful alternative to open surgery, improving patient outcomes and quality of life.