Novosti
Khirurgii
This journal is
indexed in Scopus









Year 2017 Vol. 25 No 1

UROLOGY

DOI: https://dx.doi.org/10.18484/2305-0047.2017.1.53   |  

R.A. NAKONECHNYY

PROGNOSTIC MARKERS OF ENDOVESICAL TREATMENT OF VESICOURETERAL REFLUX IN CHILDREN

Lviv Danylo Halytsky National Medical University
Lviv,
Ukraine

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 R=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: R=2,08 [0,82-5,28], RR=1,54 [0,92-2,57] if compared with R=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.

Keywords: vesicoureteral reflux, endoscop, cystoscopy, bladder, prognostic cystoscopic markers, treatment, final results
p. 53-59 of the original issue
References
  1. Lesovoi VN, Turenko IA, Dubinina AN. Otsenka otdalennykh rezul'tatov endoskopicheskoi korrektsii puzyrno-mochetochnikovogo refliuksa [Evaluation of long-term results of endoscopic correction of vesicoureteral reflux]. Eksper Kln Meditsina. 2009;3:128-31.
  2. Seimvs'kii DA. Vrodzhen vadi sechovodu u dtei [Congenital ureter in children]. Prirod Meditsina. 2011 Sent;(7):14-15.
  3. Straub J, Apfelbeck M, Karl A, Khoder W, Lellig K, Tritschler S et al. Vesico-ureteral reflux: diagnosis and treatment recommendations. Urologe A. 2016 Jan;55(1):27-34. doi: 10.1007/s00120-015-0003-3. Review. German.
  4. Crozier J, Aw I, Tan PH, Clarke D. Taking the STING out of ureteral obstruction. J Endourol Case Rep. 2016 Oct 1; 2(1):166-68.
  5. Khawaja MA, Nawaz G, Jamil MI, Muhammad S, ur Rehman A, Shohab D, et al. Efficacy of endoscopic treatment for primary vesicoureteric reflux in children. J Ayub Med Coll Abbottabad. 2015 Oct-Dec;27(4):861-64.
  6. Lee LC, Lorenzo AJ, Koyle MA. The role of voiding cystourethrography in the investigation of children with urinary tract infections. Can Urol Assoc J. 2016 May-Jun;10(5-6):210-14.
  7. Arlen AM, Cooper CS. Controversies in the management of vesicoureteral reflux. Curr Urol Rep. 2015 Sep;16(9):64. doi: 10.1007/s11934-015-0538-2. Review.
  8. Puri P, Hunziker M. Vesicoureteral reflux. In: Ziegler MM, Azizkhan RG, von Allmen D, Weber TR, editors. Operative Pediatric Surgery. 2nd ed. McGraw-Hill Education; 2014. p. 818-27.
  9. Kirsch AJ1, Perez-Brayfield M, Smith EA, Scherz HC. The modified sting procedure to correct vesicoureteral reflux: improved results with submucosal implantation within the intramural ureter. J Urol. 2004 Jun;171(6 Pt 1):2413-6.
  10. Chertin B, Puri P. Endoscopic management of vesicoureteral reflux: does it stand the test of time? Eur Urol. 2002;42:598-606.
  11. Elder JS1, Shah MB, Batiste LR, Eaddy M. Part 3: Endoscopic injection versus antibiotic prophylaxis in the reduction of urinary tract infections in patients with vesicoureteral reflux. Curr Med Res Opin. 2007 Sep;23(Suppl 4):S15-20.
  12. Dogan HS, Altan M, Citamak B, Bozaci AC, Koni A, Tekgul S. Factors affecting the success of endoscopic treatment of vesicoureteral reflux and omparison of two dextranomer based bulking agents: does bulking substance matter? J Pediatr Urol. 2015 Apr; 11(2):90.e1-5. doi: 10.1016/j.jpurol.2014.12.009.
  13. Tekgul, S., Dogan, H.S., Erdem, E., Hoebeke, P., Kocvara, R., Nijman, J.M. et al. Guidelines on paediatric urology. Eur Assoc Urol. 2015; Available from: http://uroweb.org/wp-content/uploads/EAU-Guidelines-Paediatric-Urology-2015.pdf.
  14. Lee S, Jeong SC, Chung JM, Lee SD. Secondary surgery for vesicoureteral reflux after failed endoscopic injection: Comparison to primary surgery. Investig Clin Urol. 2016 Jan;57(1):58-62. doi: 10.4111/icu.2016.57.1.58.
  15. Lee EK, Gatti JM, Demarco RT, Murphy JP. Long-term followup of dextranomer/hyaluronic acid injection for vesicoureteral reflux: late failure warrants continued followup. J Urol. 2009 Apr;181(4):1869-74; discussion 1874-5. doi: 10.1016/j.juro.2008.12.005.
Address for correspondence:
79010, Ukraine, Lviv,
Pecarskaya str., 69,
Lviv Danylo Halytsky National
Medical University,
Department of Pediatric Surgery,
Tel.: + 38-032-293-97-39
E-mail: nrostyslav@gmail.com
Rostyslav A. Nakonechnyy
Information about the authors:
Nakonechnyy R.A. Post-graduate student of the pediatric surgery department, Lviv Danylo Halytsky National Medical University
Contacts | ©Vitebsk State Medical University, 2007