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Subureteric Injection In The Treatment Of Vesicoureteral Reflux: Single Center Experience

Year 2017, Volume: 31 Issue: 1, 1 - 7, 26.05.2017

Abstract

Objective: Subureteric agent injection is preferred increasingly
in the treatment of vesico-ureteral reflux (VUR) disease. In this study, we
aimed to evaluate the long term results of patients who had VUR disease treated
with subureteric agent injection.

We
used radionuclide direct cystogram or conventional voiding cystography to
control VUR presence at the postoperative 3rd month. Subureteric agent
injection was repeated who had persistence VUR.

Results: A total 222 ureter of
156 patients (115 female, 41 male) who had VUR were treated. Mean age of
patients were 6.4±3.4 (8 month-16 years). Patients who had overactive bladder
in urodynamic tests before using subureteric agent injection were treated with
oxybutynin HCl. When the patients were evaluate between 1993-2003 years,
2003-2009 years and 2009-2014 years, we found the success rate increasing as
76%, 83% and 92%; respectively. The overall success rate was found 86%. At the
third or fourth subureteric agent injections, the success rate decreased to
15%. Follow up time of the patients performed subureteric agent injections was
22.2± 17.6 (2 -72) months.

Conclusion: Subureteric agent injections for VUR
treatment is an effective method with high success rate and low complication
rate. If VUR still exists after the second subureteric injection,
ureteroneocystostomy must be preferred.


References

  • Referans1 Sargent MA. What is the normal prevelance of vesicoureteral reflux? Pediatr Radiol 2000;30:587-93.
  • Referans2 Skoog SJ, Peters CA, Arant BS JR, et al. Pediatric vesicoureteral reflux guidelines panel summary report: Clinical practice guidelines before screening siblings of children with vesicoureteral reflux and neonates/infants with prenatal hydronephrosis. J Urol 2012;184:1145-51.
  • Referans3 Greenbaum LA, Mesrobian HG. Vesicoureteral reflux. Pediatr Clin North Am. 2006;53:413-27.
  • Referans4 Peters CA, Skoog SJ, Arant BS JR, et al. Summary of the AUA guideline on management of vesicoureteral reflux in children. J Urol 2010;184:1134.
  • Referans5 Estrada CR Jr, Passerotti CC, Graham DA, et al. Nomograms for predicting annual resolution rate of primary vesicoureteral reflux: results from 2462 children. J Urol 2009;182:1535-41.
  • Referans6 Tekgül S, Riedmiller H, Hoebeke P, et al. EAU Guidelines on vesicoureteral reflux in children. European Urology 2012;62:534-42.
  • Referans7 Sunaryo PL, Cambareri GM, Winston DG, et al. Vesico-ureteric reflux (VUR) management and screening patterns: are paediatric urologists following the 2010 American Urological Association (AUA) guidelines? BJU Int 2014;114:761-9.
  • Referans8 Nelson CP, Copp HL, Lai J, et al. Is a availability of endoscopic changing initial management of vesicoureteral reflux? J urol 2009;182:1152-7.
  • Referans9 Cihertin B, Kocherov S. Longterm results of endoscopic treatment of vesicoureteral reflux with different tissue – augmenting substances. J Pediatr Urol 2010;6:251-6.
  • Referans10 Copp HL, Nelson CP, Shortliffe LD et al. Compliance with antibiotic prophylaxis in children with vezicoureteral reflux: Results from a national pharmacy claims database. J. Urol 2010;183:1994-9.
  • Referans11 Coleman R. Early management and long-term outcomes in primary vesico-ureteric reflux. BJU Int 2011;108:3-8.
  • Referans12 Şencan A, Yıldırım H, Keramettin UO et al. Open ureteroneocystostomy after fail edendoscopic injection with three different bulking agents for the treatment of vesicoureteral reflux. J Pediatr Surg 2014;49:1652-5.
  • Referans13 Puri P, O’donnell B. Correction of experimentally produced vesicoureteral reflux in piglet by intravesical injection of Teflon. BR Med J 1984;289:5.
  • Referans14 Menezes MN, Puri P. The role of endoscopic treatement in the management of grade V primary vesicoureteral reflux. Eur Urol 2007;52:1505-9.
  • Referans15 Puri P, Kutasy B, Colhoun H, et al. Single center experience with endoscopic subureteral dextranomer/Hyaluronic acid injection as first line treatment in 1551 chidren with intermediate and high grade vesicoureteral reflux. J Urol 2012;188:1485-9.
  • Referans16 Matouschek E. Die behand lung des vesikorenalen refluxes durch transurethrale inspritzung von teflonpaste. Urologe 1981;20:263-4
  • Referans17 Kershen RT, Atala A. New advances in injectiable therapies for the treatment of incontinence and vesicoureteral reflux. Urol clin North Am 1999;26:81-94.
  • Referans18 Caldamone AA, Diamond DA Long term results of the endoscopic correction of vesicoureteral reflux in children using autologous chondrocytes. J Urol 2002;165: 2224- 7.
  • Referans19 Al- Hunayan AA, Kehinde EO, Elsalam MA,et al. Outcome of endoscopic treatment for vesicoureteral reflux in children using polydimetthylsiloxane. J Urol 2002;168: 2181-3.
  • Referans20 Oswald J, Riccabona M, Lusuardi L, et al. Prospective comprasion and 1-year follow-up of a single endoscopic subureteral polydimethylsiloxane versus dextranomer/hyaluronic acid copolymer injection for treatment of vesicoureteral reflux in children. Urology 2002;60:894-7.
  • Referans21 Elder JS, Diaz M, Caldamone AA et al. Endoscopic therapy for vesicoureteral reflux: a meta-analysis, I: Reflux resolution and urinary tract infection. J Urol. 2006;175:716-22.
  • Referans22 Seunsoo Lee, Seung Chan Jeong, Jae Min Chung, Sang Don Lee. Secondary surgery for vesicoureteral reflux after failed endoscopic injection: Comparison to primary surgery. Investing Clın Urol. 2016;57:58-62.
  • Referans23 Chertin B, Prosolovich K, Aharon S, Nativ O, Halachmi S. Surgical reimplantation for the correction of vesicoureteral reflux following failed endoscopic injection. Adv Urol 2011;2011: 352716.
  • Referans24 Moreira-Pinto J, Osorio A, Pereira J, Sousa C, de Castro JL, Reis A. Ureteroneocystostomy after failed dextranomer/hyaluronic acid copolymer injection for vesicoureteral reflux treatment. J Pediatr Urol 2013;9:665-9.
  • Referans25 Lackgren G, Wahlin N, Sköldenberg E, et al. Long-term follow up children treated dextranomer/hyaluronic acid copolymer for vesicoureteral reflux. J. Urol 2001;166:1887-92.
  • Referans26 Vandersteen DR, Routh JC, Kirsch AJ, et al. Postoperative ureteral obstruction after subureteral injection of dextranomer/hyaluronic acid copolymer J. Urol 2006;176:1593-5.
  • Referans27 Koff SA, Wagner TT, Jayanthi VR. The relationship among dysfunctional elimination syndromes, primary vesicoureteral reflux and urinary tract infections in children. J Urol 1998;160:1019-22.
  • Referans28 Snodgrass W. The impact of treated dysfunctional voiding on the nonsurgical management of vesicoureteral reflux. J Urol 1998;160:1823-5.
  • Referans29 Capozza N, Patricolo M, Lais A, et al. Endoscopic treatment of vesicoureteral reflux: twelfe years experience. Urol Int 2001;67:228-31.
  • Referans30 Lavelle MT, Conlin MJ, Skoog SJ. Subureteric injection of Deflüx for correction of reflux analysis of factors predicting success. Urology 2005;65;564-7.

Vezikoüreteral reflü tedavisinde subüreterik enjeksiyon tedavisi: Tek merkez deneyimi

Year 2017, Volume: 31 Issue: 1, 1 - 7, 26.05.2017

Abstract

Amaç:
Vezikoüreteral reflü (VÜR) tedavisinde subüretik enjeksiyon (SE) yaygın olarak
kullanılmaktadır. Bu çalışmada VÜR tanısıile SE uygulanan hastaların uzun
dönemli sonuçlarının değerlendirilmesi amaçlanmıştır.



Gereç
ve yöntem: Anabilim Dalı’mızda 1993-2014 yılları arasında VÜR
tanısı ile SE uygulanan 156 hastanın bilgileri retrospektif olarak incelendi.
Hastaların demografik özellikleri, VÜR özellikleri, tedavi başarısı ve
komplikasyonlar açısından derlendi. SE tedavisinde enjeksiyon materyali üreter
orifisine submukozal olarak tek noktadan uygulandı. Hastalar postoperatif 3.
ayda konvansiyonel voiding sistoüretogram ya da radyonüklid işeme sistografisi
ile değerlendirildi. VÜR’ü sebat eden hastalarda SE uygulaması tekrarlandı.



Bulgular: VÜR saptanan 156
hastada (115 kız, 41 erkek), 222 üreter tedavi edildi. Hastaların yaş
ortalaması 6,4±3,4yıl (8 ay-16 yaş) idi. SE öncesinde ürodinamide aşırı aktif
mesane bulguları saptanan hastalar oksibutinin HCl ile tedavi edildi. 1993-2003
yılları arası başarı oranı %76 iken, 2003-2009 yılları arasında %83 ve 2009-2014
arasında ise %92’ye yükselmiştir. Genel başarı oranı % 86 olarak saptandı.
Üçüncü ve 4. SE uygulamalarında başarı oranı ortalama %14’e idi. SE tedavisi
uygulanan hastaların ortalama izlem süresi 22,2± 17,6 (2 ay-72 ay) aydı.



Sonuç: VÜR tedavisinde SE uygulaması yüksek başarı
ve düşük komplikasyon oranlarıyla etkin olarak kullanılmaktadır. Ancak ikinci
SE uygulamasından sonra sebat eden VÜR’ler için üreteroneosistostomi
uygulanması tercih edilmelidir.




References

  • Referans1 Sargent MA. What is the normal prevelance of vesicoureteral reflux? Pediatr Radiol 2000;30:587-93.
  • Referans2 Skoog SJ, Peters CA, Arant BS JR, et al. Pediatric vesicoureteral reflux guidelines panel summary report: Clinical practice guidelines before screening siblings of children with vesicoureteral reflux and neonates/infants with prenatal hydronephrosis. J Urol 2012;184:1145-51.
  • Referans3 Greenbaum LA, Mesrobian HG. Vesicoureteral reflux. Pediatr Clin North Am. 2006;53:413-27.
  • Referans4 Peters CA, Skoog SJ, Arant BS JR, et al. Summary of the AUA guideline on management of vesicoureteral reflux in children. J Urol 2010;184:1134.
  • Referans5 Estrada CR Jr, Passerotti CC, Graham DA, et al. Nomograms for predicting annual resolution rate of primary vesicoureteral reflux: results from 2462 children. J Urol 2009;182:1535-41.
  • Referans6 Tekgül S, Riedmiller H, Hoebeke P, et al. EAU Guidelines on vesicoureteral reflux in children. European Urology 2012;62:534-42.
  • Referans7 Sunaryo PL, Cambareri GM, Winston DG, et al. Vesico-ureteric reflux (VUR) management and screening patterns: are paediatric urologists following the 2010 American Urological Association (AUA) guidelines? BJU Int 2014;114:761-9.
  • Referans8 Nelson CP, Copp HL, Lai J, et al. Is a availability of endoscopic changing initial management of vesicoureteral reflux? J urol 2009;182:1152-7.
  • Referans9 Cihertin B, Kocherov S. Longterm results of endoscopic treatment of vesicoureteral reflux with different tissue – augmenting substances. J Pediatr Urol 2010;6:251-6.
  • Referans10 Copp HL, Nelson CP, Shortliffe LD et al. Compliance with antibiotic prophylaxis in children with vezicoureteral reflux: Results from a national pharmacy claims database. J. Urol 2010;183:1994-9.
  • Referans11 Coleman R. Early management and long-term outcomes in primary vesico-ureteric reflux. BJU Int 2011;108:3-8.
  • Referans12 Şencan A, Yıldırım H, Keramettin UO et al. Open ureteroneocystostomy after fail edendoscopic injection with three different bulking agents for the treatment of vesicoureteral reflux. J Pediatr Surg 2014;49:1652-5.
  • Referans13 Puri P, O’donnell B. Correction of experimentally produced vesicoureteral reflux in piglet by intravesical injection of Teflon. BR Med J 1984;289:5.
  • Referans14 Menezes MN, Puri P. The role of endoscopic treatement in the management of grade V primary vesicoureteral reflux. Eur Urol 2007;52:1505-9.
  • Referans15 Puri P, Kutasy B, Colhoun H, et al. Single center experience with endoscopic subureteral dextranomer/Hyaluronic acid injection as first line treatment in 1551 chidren with intermediate and high grade vesicoureteral reflux. J Urol 2012;188:1485-9.
  • Referans16 Matouschek E. Die behand lung des vesikorenalen refluxes durch transurethrale inspritzung von teflonpaste. Urologe 1981;20:263-4
  • Referans17 Kershen RT, Atala A. New advances in injectiable therapies for the treatment of incontinence and vesicoureteral reflux. Urol clin North Am 1999;26:81-94.
  • Referans18 Caldamone AA, Diamond DA Long term results of the endoscopic correction of vesicoureteral reflux in children using autologous chondrocytes. J Urol 2002;165: 2224- 7.
  • Referans19 Al- Hunayan AA, Kehinde EO, Elsalam MA,et al. Outcome of endoscopic treatment for vesicoureteral reflux in children using polydimetthylsiloxane. J Urol 2002;168: 2181-3.
  • Referans20 Oswald J, Riccabona M, Lusuardi L, et al. Prospective comprasion and 1-year follow-up of a single endoscopic subureteral polydimethylsiloxane versus dextranomer/hyaluronic acid copolymer injection for treatment of vesicoureteral reflux in children. Urology 2002;60:894-7.
  • Referans21 Elder JS, Diaz M, Caldamone AA et al. Endoscopic therapy for vesicoureteral reflux: a meta-analysis, I: Reflux resolution and urinary tract infection. J Urol. 2006;175:716-22.
  • Referans22 Seunsoo Lee, Seung Chan Jeong, Jae Min Chung, Sang Don Lee. Secondary surgery for vesicoureteral reflux after failed endoscopic injection: Comparison to primary surgery. Investing Clın Urol. 2016;57:58-62.
  • Referans23 Chertin B, Prosolovich K, Aharon S, Nativ O, Halachmi S. Surgical reimplantation for the correction of vesicoureteral reflux following failed endoscopic injection. Adv Urol 2011;2011: 352716.
  • Referans24 Moreira-Pinto J, Osorio A, Pereira J, Sousa C, de Castro JL, Reis A. Ureteroneocystostomy after failed dextranomer/hyaluronic acid copolymer injection for vesicoureteral reflux treatment. J Pediatr Urol 2013;9:665-9.
  • Referans25 Lackgren G, Wahlin N, Sköldenberg E, et al. Long-term follow up children treated dextranomer/hyaluronic acid copolymer for vesicoureteral reflux. J. Urol 2001;166:1887-92.
  • Referans26 Vandersteen DR, Routh JC, Kirsch AJ, et al. Postoperative ureteral obstruction after subureteral injection of dextranomer/hyaluronic acid copolymer J. Urol 2006;176:1593-5.
  • Referans27 Koff SA, Wagner TT, Jayanthi VR. The relationship among dysfunctional elimination syndromes, primary vesicoureteral reflux and urinary tract infections in children. J Urol 1998;160:1019-22.
  • Referans28 Snodgrass W. The impact of treated dysfunctional voiding on the nonsurgical management of vesicoureteral reflux. J Urol 1998;160:1823-5.
  • Referans29 Capozza N, Patricolo M, Lais A, et al. Endoscopic treatment of vesicoureteral reflux: twelfe years experience. Urol Int 2001;67:228-31.
  • Referans30 Lavelle MT, Conlin MJ, Skoog SJ. Subureteric injection of Deflüx for correction of reflux analysis of factors predicting success. Urology 2005;65;564-7.
There are 30 citations in total.

Details

Journal Section Articles
Authors

Serdar Şıvye This is me

Osman Zeki Karakuş This is me

Oğuz Ateş

Gülce Hakgüder This is me

Feza Miraç Akgür This is me

Mustafa Olguner This is me

Publication Date May 26, 2017
Submission Date June 27, 2016
Published in Issue Year 2017 Volume: 31 Issue: 1

Cite

Vancouver Şıvye S, Karakuş OZ, Ateş O, Hakgüder G, Akgür FM, Olguner M. Vezikoüreteral reflü tedavisinde subüreterik enjeksiyon tedavisi: Tek merkez deneyimi. J DEU Med. 2017;31(1):1-7.