Avoiding routine postoperative voiding cystourethrogram: Predicting radiologic success for endoscopically treated vesicoureteral reflux

  • Peter (Zhan Tao) Wang London Health Sciences Centre Western University http://orcid.org/0000-0002-9533-5748
  • Ahmed Abdelhalim Mansoura Urology and Nephrology Center Mansoura University
  • Arman Walia Children's Hospital of Orange County University of California, Irvine
  • Elias Wehbi Children's Hospital of Orange County University of California, Irvine
  • Sumit Dave London Health Sciences Centre Western University
  • Antoine Khoury Children's Hospital of Orange County University of California, Irvine
Keywords: vesicoureteral reflux, voiding cystourethrogram

Abstract

Introduction: Variability in the success rates for the endoscopic correction of vesicoureteral reflux (VUR) has prompted a debate regarding the use of routine postoperative voiding cystourethrogram (VCUG). This study examines the predictive performance of intraoperative mound morphology (IMM) and the presence of a postoperative ultrasound mound (PUM) on radiologic success, as well as investigates the role of using these two predictive factors as a composite tool to predict VUR resolution after endoscopic treatment.

Methods: This retrospective study included children with primary VUR who underwent endoscopic correction with a double hydrodistension-implantation technique (HIT) and dextranomer/ hyaluronic acid copolymer. IMM was assessed intraoperatively. The presence of a PUM and VUR resolution were assessed by postoperative ultrasound (US) and VCUG, respectively. Radiologic success was defined as VUR resolution.

Results: A total of 70 children (97 ureters) were included in the study. The overall radiologic success rate was 83.5%. There was no statistically significant association between radiologic success and IMM (85.2% with excellent and 87.5% with “other” morphology; p=0.81). The sensitivity and specificity of PUM for radiologic success in this study was 98% and 71%, respectively, while the sensitivity and specificity of the combined prediction model were 81.9% and 85.7%, respectively.

Conclusions: We objectively demonstrated that IMM was a poor predictor of radiologic success and should be used with caution. In addition, the performance of a combined prediction model was inferior to the presence of a PUM alone. As such, selective use of postoperative VCUG may be guided solely by the presence of a PUM.

Author Biographies

Peter (Zhan Tao) Wang, London Health Sciences Centre Western University

Assistant Professor

Department of Surgery

Division of Urology

Ahmed Abdelhalim, Mansoura Urology and Nephrology Center Mansoura University

Assistant Lecturer of Urology

Department of Surgery

Division of Urology

Arman Walia, Children's Hospital of Orange County University of California, Irvine
Medical Student
Elias Wehbi, Children's Hospital of Orange County University of California, Irvine

HS Assistant Clinical Professor

Department of Urology

Sumit Dave, London Health Sciences Centre Western University

Associate Professor

Department of Surgery

Division of Urology

Antoine Khoury, Children's Hospital of Orange County University of California, Irvine

Professor and Chief of Pediatric Urology

Department of Urology

Published
2018-11-05
How to Cite
Wang, P. (Zhan T., Abdelhalim, A., Walia, A., Wehbi, E., Dave, S., & Khoury, A. (2018). Avoiding routine postoperative voiding cystourethrogram: Predicting radiologic success for endoscopically treated vesicoureteral reflux. Canadian Urological Association Journal, 13(5). https://doi.org/10.5489/cuaj.5589
Section
Original Research