Results of Preference of Subureteric Injection or Ureteroneocystostomy As the Initial or Subsequent Surgical Intervention in Vesicoureteral Reflux

Öz

The incidence of vesicoretral reflux (VUR) in childhood is 0.4-1.8%. Among the surgical treatment options, there are two different approaches: Subureteric injection (SUI) and ureteroneocystostomy (UNC). In this study, we evaluated the operation results of patients who underwent SUI and UNC for VUR. Patients who underwent surgical treatment for vesicoureteral reflux in a tertiary university hospital between 2010-2018 were retrospectively analyzed. The surgical techniques applied to the patients, whether the procedure was successful or not, and additional interventions needed afterwards were recorded. The success rates of the two different techniques applied were compared. Of the 274 patients included in the study, 219 received SUI as the first procedure, 57% of patients did not need additional intervention. After the first SUI, 13.1% of patients underwent UNC as the second procedure. A second SUI was given to 21.2% of patients. UNC was given to 5.5% of patients who received two injections, and 4% of patients were underwent a third SUI. 59.8% patients were treated with SUI alone. Reflux was treated in 65.6% of patients with a single procedure. In VUR patients, SUI should be the first treatment choice because of its high success rate, low complication risk and not preventing UNC.

Anahtar Kelimeler

• Vesicoureteral reflux
• subureteric injection
• ureteroneocystostomy

Vezikoüreteral Reflüde İlk veya Sonraki Cerrahi Girişim Olarak Subüreterik Enjeksiyon veya Üreteroneosistostomi Tercihinin Sonuçları

Öz

Çocukluk çağında vezikoretral reflü (VUR) görülme sıklığı %0,4-1,8'dir. Cerrahi tedavi seçenekleri arasında iki farklı yaklaşım bulunmaktadır: Subüreterik enjeksiyon (SUI) ve üreteroneosistostomi (UNC). Bu çalışmada, VUR nedeniyle SUI ve UNC uygulanan hastaların operasyon sonuçlarını değerlendirdik. Üçüncü basamak bir üniversite hastanesinde 2010-2018 yılları arasında vezikoüreteral reflü nedeniyle cerrahi tedavi uygulanan hastalar retrospektif olarak analiz edildi. Hastalara uygulanan cerrahi teknikler, işlem başarısı ve sonrasında ihtiyaç duyulan ek müdahaleler kaydedildi. Uygulanan iki farklı tekniğin başarı oranları karşılaştırıldı. Çalışmaya dahil edilen 274 hastanın 219'una ilk işlem olarak SUI uygulandı, %57 hastaya ek müdahale gerekmedi. İlk SUI'den sonra hastaların %13,1'ine ikinci prosedür olarak UNC uygulandı. Hastaların %21,2'sine ikinci bir SUI uygulanmıştır. İki kez enjekte edilen hastaların %5,5'ine UNC, %4'üne ise üçüncü SUI uygulandı. Hastaların %59,8'i tek başına SUI ile tedavi edildi. VUR %65,6 hastada tek işlemle tedavi edildi. VUR hastalarında SUI, yüksek başarı oranı, düşük komplikasyon riski ve UNC'yi engellememesi nedeniyle ilk tedavi seçeneği olmalıdır.

Anahtar Kelimeler

• Vezikoüreteral reflü
• subüreterik enjeksiyon
• üreteroneosistostomi

Kaynakça

1. 1. Başaklar AC. Surgical and Urological Diseases of Infants and Children, Vesicoureteral Reflux, Palme Publishing. 2006:1289-335.
2. 2. Tekgül S, Riedmiller H, Hoebeke P, et al. EAU guidelines on vesicoureteral reflux in children. Eur Urol. 2012;62[3]:534-42.
3. 3. Blumenthal I. (2006). Vesicoureteric reflux and urinary tract infection in children. Postgraduate medical journal, 82(963), 31–35.
4. 4. Naseri, M., Karimi, M., Bakhtiari, E., Tafazoli, N., Alamdaran, S. A., & Tafazoli, N. (2021). Diagnostic Values of Kidney Ultrasonography for Vesicoureteral Reflux (VUR) and High Grade VUR. Iranian journal of kidney diseases, 15(5), 328–335.
5. 5. Esposito, C., Escolino, M., Lopez, M., Farina, A., Cerulo, M., Savanelli, A., La Manna, A., Caprio, M. G., Settimi, A., & Varlet, F. (2016). Surgical Management of Pediatric Vesicoureteral Reflux: A Comparative Study Between Endoscopic, Laparoscopic, and Open Surgery. Journal of laparoendoscopic & advanced surgical techniques. Part A, 26(7), 574–580.
6. 6. Faust, W. C., Diaz, M., & Pohl, H. G. (2009). Incidence of post-pyelonephritic renal scarring: a meta-analysis of the dimercapto-succinic acid literature. The Journal of urology, 181(1), 290–298.
7. 7. Akhavan Sepahi, M., Toloii, F., Arsang Jang, S., & Hoseini, B. L. (2020). The Prevalence of Renal Scars Among Infants Under One Year Old With a First UTI With or Without VUR in Qom, Iran, 2017. Iranian journal of kidney diseases, 14(4), 308–311.
8. 8. Polito, C., Rambaldi, P. F., Signoriello, G., Mansi, L., & La Manna, A. (2006). Permanent renal parenchymal defects after febrile UTI are closely associated with vesicoureteric reflux. Pediatric nephrology (Berlin, Germany), 21(4), 521–526.

9. 9. Caione, P., Ciofetta, G., Collura, G., Morano, S., & Capozza, N. (2004). Renal damage in vesico-ureteric reflux. BJU international, 93(4), 591–595.
10. 10. Nagler, E. V., Williams, G., Hodson, E. M., & Craig, J. C. (2011). Interventions for primary vesicoureteric reflux. The Cochrane database of systematic reviews, (6), CD001532.
11. 11. Radmayr C. Wilcox DT, Godbole PP, Koyle MA : Vesicoureteric reflux, in Pediatric Urology: Surgical Complications and Management, Wiley-Blackwell, USA, 2008, pp:111-116.
12. 12. Elder, J. S., Diaz, M., Caldamone, A. A., Cendron, M., Greenfield, S., Hurwitz, R., Kirsch, A., Koyle, M. A., Pope, J., & Shapiro, E. (2006). Endoscopic therapy for vesicoureteral reflux: a meta-analysis. I. Reflux resolution and urinary tract infection. The Journal of urology, 175(2), 716–722.
13. 13. Chertin, B., Natsheh, A., Fridmans, A., Shenfeld, O. Z., & Farkas, A. (2009). Renal scarring and urinary tract infection after successful endoscopic correction of vesicoureteral reflux. The Journal of urology, 182(4 Suppl), 1703–1706.
14. 14. Garcia-Aparicio, L., Rovira, J., Blazquez-Gomez, E., García-García, L., Giménez-Llort, A., Rodo, J., & Morales, L. (2013). Randomized clinical trial comparing endoscopic treatment with dextranomer hyaluronic acid copolymer and Cohen's ureteral reimplantation for vesicoureteral reflux: longterm results. Journal of pediatricurology,9(4),483487.
15. 15. Çitamak, B., Bozaci, A. C., Altan, M., Haberal, H. B., Kahraman, O., Ceylan, T., Doğan, H. S., & Tekgül, S. (2019). Surgical outcome of patients with vesicoureteral reflux from a single institution in reference to the ESPU guidelines: a retrospective analysis. Journal of pediatric urology, 15(1), 73.e1–73.e6.