Durasphere® EXP: a non-biodegradable agent for treatment of primary Vesico-Ureteral reflux in children

ABSTRACT Introduction: Durasphere® EXP (DEXP) is a compound of biocompatible and non--biodegradable particles of zirconium oxide covered with pyrolytic carbon. The aim of this study is to evaluate the durability of off-label use of DEXP in the treatment of primary vesicoureteral reflux in children. Materials and Methods: Patients who underwent subureteric injection of DEXP for the correction of primary VUR were retrospectively reviewed. Patients aged >18 years as well as those who had grade-I or -V VUR, anatomic abnormalities (duplicated system, hutch diverticulum), neurogenic bladder or treatment refractory voiding dysfunction were excluded. Radiologic success was defined as the resolution of VUR at the 3rd month control. Success was radiographically evaluated at the end of the first year. Results: Thirty-eight patients (9 boys, 29 girls; mean age, 6.3±2.7 years) formed the study cohort. Forty-six renal units received DEXP (grade II: 22; grade III: 18; grade IV: 6). Mean volume per ureteric orifice to obtain the mound was 0.70±0.16mL. First con- trol VCUG was done after 3 months in all patients. After the first VCUG, 6 patients had VUR recurrence. Short-term radiologic success of DEXP was 84.2%. Rate of radiologic success at the end of the first year was 69.4% (25/32). Lower age (p:0.006) and lower amount of injected material (p:0.05) were associated with higher success rates at the end of 1 year. Conclusion: This is the first study to assess the outcomes of DEXP for treatment of primary VUR in children. After 1 year of follow-up, DEXP had a 69.4% success rate.

Does the Modified STING Method Increase the Success Rate in the Management of Moderate or High-Grade Reflux?

PURPOSE: To evaluate the efficacy of subureteral injection types in patients with middle- to high-grade vesicoureteral reflux (VUR). MATERIALS AND METHODS: Between June 1999 and September 2010, subureteral dextranomer was applied at our clinic to 149 patients (214 refluxing ureters) with grades II, III, and IV VUR. Group 1 consisted of 54 patients (80 ureters), and group 2 consisted of 95 patients (134 ureters). The standard subureteric transurethral injection (STING) procedure was applied to group 1, and the modified STING procedure was applied to group 2. A second and if needed a third injection was applied to unsuccessfully treated patients. The mean follow-up period was 2 years. Patients were evaluated by cystography and ultrasonography in the third month of follow-up. RESULTS: VUR was resolved completely after a single injection in 54/80 ureters (67.5%) in group 1 and in 94/134 ureters (70.1%) in group 2. Overall successes after a second or a third injection were 61/80 (76.2%) and 111/134 (82.8%), respectively. There was a statistically significant difference between the groups only for grade IV reflux following multiple injections (p<0.05). CONCLUSIONS: Endoscopic treatment of VUR is a recommended treatment because it is minimally invasive, efficient, and repeatable. Our study confirmed that a modified STING procedure can be an alternative treatment to the standard technique.

Does the Modified STING Method Increase the Success Rate in the Management of Moderate or High-Grade Reflux?

PURPOSE: To evaluate the efficacy of subureteral injection types in patients with middle- to high-grade vesicoureteral reflux (VUR). MATERIALS AND METHODS: Between June 1999 and September 2010, subureteral dextranomer was applied at our clinic to 149 patients (214 refluxing ureters) with grades II, III, and IV VUR. Group 1 consisted of 54 patients (80 ureters), and group 2 consisted of 95 patients (134 ureters). The standard subureteric transurethral injection (STING) procedure was applied to group 1, and the modified STING procedure was applied to group 2. A second and if needed a third injection was applied to unsuccessfully treated patients. The mean follow-up period was 2 years. Patients were evaluated by cystography and ultrasonography in the third month of follow-up. RESULTS: VUR was resolved completely after a single injection in 54/80 ureters (67.5%) in group 1 and in 94/134 ureters (70.1%) in group 2. Overall successes after a second or a third injection were 61/80 (76.2%) and 111/134 (82.8%), respectively. There was a statistically significant difference between the groups only for grade IV reflux following multiple injections (p<0.05). CONCLUSIONS: Endoscopic treatment of VUR is a recommended treatment because it is minimally invasive, efficient, and repeatable. Our study confirmed that a modified STING procedure can be an alternative treatment to the standard technique.

Clinical Value of Persistent but Downgraded Vesicoureteral Reflux after Dextranomer/Hyaluronic Acid Injection in Children

We aimed to investigate the clinical value of persistent but downgraded vesicoureteral reflux (VUR) after dextranomer/hyaluronic acid (Dx/HA) injection in children. The medical records of 128 children (195 ureters) who underwent Dx/HA injections for VUR were reviewed. The incidences of pre- and post-operative febrile urinary tract infections (UTIs) were analyzed in children with or without persistent VUR on voiding cystourethrography (VCUG) 3 months postoperatively. The surgical results of VUR persistent children who underwent a single additional injection were assessed. The VUR resolved completely in 100 ureters (51.3%), was persistent in 95 ureters, and newly developed in 2 ureters. The incidence of pre/post-operative febrile UTIs were 0.35 +/- 0.39 per year and 0.07 +/- 0.32 per year in VUR resolved children (P < 0.001), and 0.76 +/- 1.18 per year and 0.20 +/- 0.61 per year in VUR persistent children (P < 0.001). A single additional Dx/HA injection (44 ureters) resolved VUR in 29 ureters (65.9%), and also reduced the VUR to grade I in 7 ureters (15.9%), II in 4 (9.1%), and III in 4 (9.1%). Even in children with persistent VUR after Dx/HA injection, the incidence of febrile UTIs decreased markedly. The VUR grade significantly decreases after single additional Dx/HA injection.

Resolution of UTIs Post Deflux Injections for VUR May Be due to the Cure of BBD

No abstract available.

Reflujo vesículo ureteral en el Instituto Hondureño de Seguridad Social / Vesico-ureteral reflux in the Honduran Social Security Institute

Se realiza un estudio prospectivo longitudinal de los primeros 40 años diagnosticados y operados por padecer reflujo vésico-ureteral en la Unidad Materno Infantil de Instituto Hondureño de Seguridad Social, de noviembre de 1991 a noviembre de 1996. El objetivo fundamental del estudio es evaluar el resultado del procedimiento quirúrgico. Todos los pacientes fueron diagnoticados a través de una uretrocistografía miccional retrógada complementada con ultrasonido renal y urografía excretora. La decisión quirúrgica se tomó en base a reflujos grados IV ó V de la clasificación internacional, pacientes con malformaciones anatómicas asociadas a la unión uretero vesical y por lo menos reflujo y falla del tratamiento profiláctico luego de 4 años sucesivos de medicación. El procedimiento quirúrgico fue exitoso en el 100 por ciento de los casos que consistió en uretero -neocistostomía tipo Cohen en 36 casos y 4 tipo politano- Leadbetter. Este estudio constituye la primer serie de casos de R.V.U. operados, en ser informados en la literatura médica hondureña

Reflujo vesicoureteral: tratamento médico y quirúrgico / Vesico-ureteral reflux: medical and surgical treatment

Se analizaron retrospectivamente 37 niños con Reflujo vésico-ureteral (RVU) trados en un policlínico de nefrorología infantil entre julio de 1981 y febrero 1986. Se incluyeron sólo los R.V.U. primarios. Todos los pacientes fueron evaluados con pielografía de eliminación y uretrocistografía, con un período de seguimiento mínimo de un año. Se encontró predominio de pacientes sexo femenino mayores de 6 años. Observamos 2 casos de hipertensión arterial y tres casos con disminución de la función renal. Todos los casos presentaron infección urinaria. En 43,2% de los casos se encontró signos radiológicos de nefropatía de reflujo. Hubo 52 unidades renales con R.V.U. en los 37 pacientes, con predominio de los grados II y III. Veinte niños se trataron médicamente con quimioprofilaxis y 17 niños se operaron. De los niños tratados médicamente 10 abandonaron el tratamiento, en dos pacientes el tratamiento médico fracasó. El tratamiento quirúrgico tuvo en 16 niños de los 17 niños operados