[Endoscopic treatment of complicated vesicoureteral reflux grades III-V in infants under the age of one year].

Abstract

OBJECTIVES:

Our aim is to know the results of Endoscopic Treatment (ET) in infants with recurrent pyelonephritis and high grade (G) Vesicoureteral Reflux (VUR).

METHODS:

INCLUSION CRITERIA:

infants 2-12 months old with G III-V VUR and at least 2 pyelonephritis, one of them during antibiotic prophylaxis (AP). N = 27 infants: 19 males (70%) and 8 females. VUR was primary in 17 (63%) and secondary in 10. VUR Grade was III in 12 ureters (U) (32%), IV 16 (42%) and V 10 (26%). Polydimethylsiloxane, Hydroxiapatite and Dextranomer/ Hyaluronic Acid (DAH) were the bulking agents employed. Results Classification: Solved: G 0-I.; Improved: G II (control without AP); Persistence: III-V Open Surgery (OS) or repeated ET (1-2) was done depending on cystoscopic findings.

RESULTS:

34 ureters are available for final results; 1 G III, 2 G IV and 1 G V are waiting for a new injection. G III 11 U: 11 first and 4 second injections (1.36 Injections / ureter): Solved 9 (81.8%), Improved 1, OS 1 (9%). G IV 14 U: 14 first 3 second and 1 third injection (1.28 injections / ureter): Solved 10 (71.4%), Improved 4. No OS. G V 9 U: 9 first, 4 second and 1 third injections (1.55 injections / ureter): Solved 5 (55.6%), Improved 1, OS 3 (33.3%). Overall results: Solved: 24 U (70.58%), Improved: 6 (17.6%), OS 4 (11.8%). OS avoided 30 (88.2%): G III 91%, IV 100% and V 66.7%. Results of G III are better than G V. The only complication was 1 ureteral obstruction treated successfully with open surgery.

CONCLUSIONS:

ET can be considered the first therapeutic option in infants with G III-V VUR and pyelonephritis in spite of PA, because ET has solved VUR in 70.58% and avoided OS in 88.2% with a minimally invasive procedure and low incidence of complications.

• Authors: Carlos Miguélez Lago, Jairo Moreno Román, Manuel García Mérida, Eulogio Galiano Duro, Moises Mieles Cerchar, Fernando Ibáñez Cerrato
• Journal: Archivos espanoles de urologia (Arch Esp Urol) Vol. 61 Issue 2 Pg. 284-90 (Mar 2008) ISSN: 0004-0614 [Print] Spain
• Vernacular Title: Tratamiento endoscópico del reflujo vesico ureteral III-V complicado en lactantes menores de 1 año.
• PMID: 18491748 (Publication Type: English Abstract, Journal Article)

Topics

• Algorithms
• Cystoscopy
• Humans
• Infant
• Prospective Studies
• Pyelonephritis (etiology)
• Recurrence
• Ureteroscopy
• Urinary Tract Infections (etiology)
• Vesico-Ureteral Reflux (classification, complications, therapy)