الفهرس 
Vesicoureteral reflux: anatomic, embryologic and functional basis of etiologyOnly 14 pages are availabe for public view
 |  | from | 213 |  |  |
| | | from | 213 | | |
Abstract
Vesicoureteral reflux is one of several risks that promote upper urinary tract infection and is diagnosed in 30% to 50% of patients presenting with pyelonephritis. The goals of VUR treatment are to prevent pyelonephritis and preserve renal function. Treatment options for a child with VUR include observation without antibiotics, antibiotic prophylaxis, endoscopic injection and open surgical reimplantation. Most children diagnosed with VUR are started on antibiotic prophylaxis but compliance with therapy may be lower than previously thought. Surgical management is indicated in cases of breakthrough infections and/or new renal scarring, and includes endoscopic injection and ureteral reimplantation.
Our study was designed to evaluate the efficacy of Deflux® injection in the management of grade II and grade III primary VUR and compare it to open ureteral reimplantation using the extravesical detrusorrhaphy, considered to be the current gold standard. A control group was also included in the study comprising patients managed with continuous antibiotic prophylaxis.
Our success rate after a single endoscopic injection using either the HIT or the STING techniques was 73.5% of patients and 74% of renal units at 3 months. This was reduced to 67.6% of patients and 68% of renal units at 1 year. In regards to the results based on the grade of reflux resolution, they were 72.5% for grade II VUR and 50% for grade III VUR at 1 year. Success in our study was defined as the complete resolution of reflux as documented on VCUG.
In the open ureteral reimplantation using the extravesical detrussorrhaphy technique, we had an overall success rate of 94% of patients at 1 year, corresponding to a 96.3% of treated renal units. This was a statistically significant difference compared to the Deflux® injection (p<0.001), confirming the superiority of this treatment modality in resolving VUR, despite its more invasive nature.
In regards to the incidence of UTIs in the three groups, we did not observe any statistically significant difference. The incidence was 17.6% in the Deflux® group and 26.5% in the open surgical group and 20.5% in the control group during the study period.
No significant difference in upper tract deterioration was noted in between the three groups, on renal U/S evaluation and on 99Tc-DMSA renal cortical scan.
Mild transient hydronephrosis was noted post-operatively in 9% in the Deflux group and in 15% in the open surgical group. This resolved spontaneously in both groups without any intervention.
In terms of the complications observed after the Deflux® treatment, the most common complication observed was the occurrence of contralateral denovo reflux in the unilateral cases. This occurred in 15% of patients. All these patients underwent contralateral Deflux® injection with resolution of their VUR on follow up.
In the open surgical group, acute urinary retention was the most common post-operative complication encountered. This occurred in 4 patients with bilateral reimplantation and 1 patient with unilateral reimplantation. All 5 (15%) patients had resolution of their urinary retention with a normal voiding pattern after an average indwelling catheterization period of 5 days.
Contralateral reflux was the most common complication encountered in the management of the unilateral cases, occurring in 9% of patients in this group. All those patients underwent Deflux® injection with resolution of VUR on follow up.