Endoscopic treatment of vesicoureteric reflux with Deflux: a Canadian experience

Authors

  • Luis A. Guerra Division of Pediatric Urology, Department of Surgery, Children’s Hospital of Eastern Ontario and the University of Ottawa, Ottawa, Ont.
  • Priya Khanna Division of Pediatric Urology, Department of Surgery, Children’s Hospital of Eastern Ontario and the University of Ottawa, Ottawa, Ont.
  • Michele Levasseur Division of Pediatric Urology, Department of Surgery, Children’s Hospital of Eastern Ontario and the University of Ottawa, Ottawa, Ont.
  • John G. Pike Division of Pediatric Urology, Department of Surgery, Children’s Hospital of Eastern Ontario and the University of Ottawa, Ottawa, Ont.
  • Michael P. Leonard Division of Pediatric Urology, Department of Surgery, Children’s Hospital of Eastern Ontario and the University of Ottawa, Ottawa, Ont.

DOI:

https://doi.org/10.5489/cuaj.38

Abstract

Introduction: Vesicoureteric reflux is a common problem encountered in urologicalpractice. Traditionally, if medical management with low-dose antibioticprophylaxis failed, the only alternative was ureteroneocystostomy. Recently,promising results with subureteric injection of dextranomer/hyaluronic acidcopolymer (Deflux) have renewed interest in the endoscopic treatment ofvesicoureteric reflux (VUR).

Objective: We reviewed the outcome of the subtrigonal injection (STING)procedure with Deflux at a single pediatric hospital and included the rate ofVUR resolution and complications.

Methods: An Institutional Review Board approved the retrospective review ofall cases of STING performed with Deflux at the Children’s Hospital of EasternOntario, from April 2003 to October 2005. We used voiding cystourethrogram (VCUG) or radionuclide cystogram (RNC) for diagnosis of VUR. The most commonindications for surgery were breakthrough infection, progression ofrenal scars and parental preference. A subureteral or intra-ureteral injection,at the 6 o’clock position, delivered the material to support the ureter andcorrect VUR.

Results: We reviewed the cases of 64 patients, 47 girls (73%) and 17 boys(27%), with a mean age of 6 years (range 1–17 yr) and a mean followupof 8 months (range 2–23 mo). A total of 26 patients (41%) had bilateralVUR and 38 (59%) had unilateral VUR (90 renal units were treated). Overall cure rate was 79.7% (51/64) per child and 74% (67/90) perrenal unit. Among the 64 patients treated, 62.5% (40/64) were cured witha single injection, and a second and third injection raised the cure rateto 78% (50/64) and 79.7% (51/64), respectively. Contralateral low-gradede novo VUR was present in 7.9% (3/38) of the 38 unilateral cases.Postoperatively, de novo hydronephrosis developed in 3.3% (3/90) ofthe ureters, in 2 patients.

Conclusions: The endoscopic treatment of VUR with Deflux is a feasible outpatientprocedure, requires minimal operating room time and is associated withlow morbidity. In our study, it demonstrated a cure rate of 80% of patientsand 74% of renal units. Dysfunctional voiding and neurogenic bladder (NB) donot seem to adversely affect results. STING should be considered for failed openreimplants, because it is much less morbid than redo reimplants. Further experiencewith the material and increased use of intraureteral injection may improveour cure rates.

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Published

2012-12-10

How to Cite

Guerra, L. A., Khanna, P., Levasseur, M., Pike, J. G., & Leonard, M. P. (2012). Endoscopic treatment of vesicoureteric reflux with Deflux: a Canadian experience. Canadian Urological Association Journal, 1(1). https://doi.org/10.5489/cuaj.38

Issue

Vol. 1 No. 1 (2007): CUAJ March

Section

Original Research

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