Journal of pediatric surgery · 2017
Endoscopic injection for primary vesicoureteric reflux: Predictors of resolution and long term efficacy.
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Leung Ling, Chan Ivy Hau Yee, Chung Patrick Ho Yu, Lan Lawrence Chuen Leung, Tam Paul Kwong Hang, Wong Kenneth Kak Yuen
Аннотация
AIM: We investigated the efficacy of endoscopic-Deflux-injection in treating primary-vesicoureteric-reflux (VUR) and identified factors to predict resolution.
MATERIALS AND METHODS: Records of children treated with Deflux for primary-VUR from 1995 to 2016 were reviewed, and outcomes were investigated.
RESULTS: Eighty-eight ureters (35 bilateral, 18 unilateral) in 53 children underwent 124 injections. Thirty-five (66%) patients had single injection (13 unilateral, 22 bilateral). Fifteen (28%), two (37%), and one (2%) patients had two, three, and four injections, respectively. Overall success rate by ureters was 57% after single injection. Complete resolution occurred in 65% of ureters with VUR below grade III, 63% of grade III, 40% of grade IV, and 70% of grade V VUR. Four patients had reimplantation. The median follow up duration was 60months (range 20-216months). Univariate analysis showed that lower VUR grade (p=0.03) and absent renal scars (p=0.04) were statistically significant predictors of resolution. In multivariate analysis, absent renal scars were statistically significant (p=0.01).
CONCLUSION: We demonstrated efficacy of endoscopic-Deflux-injection as the first line treatment for primary-VUR. Absent renal scar and lower VUR grade were statistically significant predictors of resolution after single injection.
TYPE OF STUDY: Case-Control / Retrospective Comparative Study.
LEVEL OF EVIDENCE: Level III.
MATERIALS AND METHODS: Records of children treated with Deflux for primary-VUR from 1995 to 2016 were reviewed, and outcomes were investigated.
RESULTS: Eighty-eight ureters (35 bilateral, 18 unilateral) in 53 children underwent 124 injections. Thirty-five (66%) patients had single injection (13 unilateral, 22 bilateral). Fifteen (28%), two (37%), and one (2%) patients had two, three, and four injections, respectively. Overall success rate by ureters was 57% after single injection. Complete resolution occurred in 65% of ureters with VUR below grade III, 63% of grade III, 40% of grade IV, and 70% of grade V VUR. Four patients had reimplantation. The median follow up duration was 60months (range 20-216months). Univariate analysis showed that lower VUR grade (p=0.03) and absent renal scars (p=0.04) were statistically significant predictors of resolution. In multivariate analysis, absent renal scars were statistically significant (p=0.01).
CONCLUSION: We demonstrated efficacy of endoscopic-Deflux-injection as the first line treatment for primary-VUR. Absent renal scar and lower VUR grade were statistically significant predictors of resolution after single injection.
TYPE OF STUDY: Case-Control / Retrospective Comparative Study.
LEVEL OF EVIDENCE: Level III.