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Year 2017 Vol. 25 No 1
PROGNOSTIC MARKERS OF ENDOVESICAL TREATMENT OF VESICOURETERAL REFLUX IN CHILDREN
Lviv Danylo Halytsky National Medical University
Objectives. To determine cystoscopic prognostic markers of treatment effectiveness in children with different clinical forms of vesicoureteral reflux (VUR) for an adequate patients’ treatment and defect correction.
Methods. The patients (n=270) with various forms of VUR of II-IV grades at the age from 6 months up to 14 years the structure of the ureter ostium was analyzed during the endovesical treatment. Half a year after the endovesical treatment a cystoscopic picture was evaluated in 64 patients with VUR of I-IV grades in whom VUR of stage remained in the same condition or decreased. The position of the “volcano shape» protrusion, migration and extrusion of the implant and if the implant bulged – the hydrodilatation grade of the ureteral orifice sprawled on it were studied.
Results. Six months after a single implantation the effectiveness of the minimally invasive treatment of VUR (II grades) was 87,84%, of III – 83,45% and of IV – 39,22%. The effectiveness of endovesical VUR re-treatment of I-IV grades reached 57,81%, which in general made gain on recovery by 13,7%. Generally, minimally invasive intervention efficiency has risen up to 90%. The lack of “volcano shape» protrusion after the first endovesical procedure turned out to be an evident negative prognostic marker regarding the effectiveness of repeated implantation – OR=0,24 [0,07-0,9], RR=0,36 [0,12-1,05], and the migration of the implant in the lateral direction was less pronounced negative marker – ÎR=0,76 [0,31-1,85], RR=0,84 [0,46-1,51].
Reducing the «volcano shape» protrusion and its displacement to the medial direction are positive prognostic markers regarding the effective re-implantation. The association was more significant with implant volume loss: ÎR=2,08 [0,82-5,28], RR=1,54 [0,92-2,57] if compared with ÎR=1,71 [0,69-4,25] and RR=1,39 [0,82-2,34] in case of migration to the midline of the bladder.
Conclusion. While planning the endovesical re-treatment of VUR the personalized approach to a patient is necessary considering the prognostic cystoscopic markers.
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79010, Ukraine, Lviv,
Pecarskaya str., 69,
Lviv Danylo Halytsky National
Department of Pediatric Surgery,
Tel.: + 38-032-293-97-39
Rostyslav A. Nakonechnyy
Nakonechnyy R.A. Post-graduate student of the pediatric surgery department, Lviv Danylo Halytsky National Medical University