Routine delayed voiding cystourethography after initial successful endoscopic treatment with Dextranomer/Hialuronic Acid Copolimer (Dx/HA) of vesicoureteral reflux (VUR). Is it necessary?

Actas Urol Esp. 2016 Dec;40(10):635-639. doi: 10.1016/j.acuro.2016.02.007. Epub 2016 May 6.
[Article in English, Spanish]

Abstract

Introduction: Some guidelines recommend an early voiding cystourethrography (VCUG) after endoscopic treatment of vesicoureteral reflux (VUR), but there's no consensus if it's necessary a long-term follow-up in these patients. The aim of our study is analyze if it's necessary a delayed VCUG after initial successful treatment with Dx/HA.

Material and method: We have reviewed all medical charts of patients that underwent Dx/HA treatment from 2006 to 2010. We have selected patients with initial successful treatment and more than 3 years of radiological and clinical follow-up. We have analyzed late clinical and radiological outcomes.

Results: One hundred and sixty children with 228 refluxing ureters underwent Dx/HA endoscopic treatment with a mean follow-up of 52.13 months. Early VCUG was performed in 215 ureters with an initial successful rate of 84.1%. The group of study was 94/215 ureters with more than 3 years of follow-up with a delayed VCUG. VUR was still resolved in 79,8% of the ureters. Clinical success rate was 91.7%. The incidence of febrile urinary tract infection in those patients with cured VUR and those with a relapsed VUR was 8 and 15%, respectively; but there were no significant differences. We have not found any variable related with relapsed VUR except those ureters that initially received 2 injections (P<.05).

Conclusion: If our objective in the treatment of VUR is to reduce the incidence of febrile urinary tract infection it is not necessary to perform a delayed VCUG even though the long-term radiological outcomes is worse than clinical outcome.

Keywords: Children; Cistografía; Cystography; Endoscopia; Endoscopy; Infancia; Reflujo vesicoureteral; Vesicoureteral reflux.

MeSH terms

  • Child, Preschool
  • Cystography*
  • Cystoscopy*
  • Dextrans / therapeutic use*
  • Female
  • Follow-Up Studies
  • Humans
  • Hyaluronic Acid / therapeutic use*
  • Male
  • Remission Induction
  • Retrospective Studies
  • Time Factors
  • Ureteroscopy*
  • Urethra / diagnostic imaging*
  • Urination
  • Vesico-Ureteral Reflux / diagnostic imaging*
  • Vesico-Ureteral Reflux / therapy*

Substances

  • Dextrans
  • dextranomer-hyaluronic acid copolymer
  • Hyaluronic Acid