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Comez I, Ucar T, Telli O, Gunaydin B, Silay MS. Does previous endoscopic subureteric injection (STING) effect the outcomes of robot-assisted laparoscopic ureteral reimplantation surgery (RALUR) in children? J Pediatr Urol 2023; 19:800.e1-800.e6. [PMID: 37607849 DOI: 10.1016/j.jpurol.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND There is lack of evidence on the success of robot-assisted laparoscopic ureteral reimplantation (RALUR) for the treatment of vesicoureteral reflux (VUR) who had prior intervention. OBJECTIVE This study aimed to evaluate the effect of previous unsuccessful STING on the outcomes of RALUR in children. STUDY DESIGN A total of 67 children treated with RALUR by a single surgeon for the treatment of VUR were scanned between February 2018 and April 2022. Two patients were excluded from the final data analysis due to the presence of a megaureter. Patients were divided into two groups: those with a history of STING (Group A - n:14) and those without STING (Group B - n:51). Patient characteristics, previous numbers of injections, console time, total operative time, perioperative and postoperative complications and clinical success data were collected. Clavien Dindo and Satava complication scales were used as the standard record of peri and postoperative complications. Radiographic success was defined as absence of reflux detected on postoperative voiding cystourethrography, whereas clinical success was defined as the absence of a febrile urinary tract infection during the follow-up. Mann-Whitney U and Chi-square tests and Fisher exact test were used where appropriate. RESULTS A total of 36 (55.3%) female versus 29 (44.6%) male patients were operated for 96 refluxive ureters. Nearly half of the patients were with bilateral VUR (n = 31). The mean follow-up was 20.2 ± 15.4 months. The median age of patients was 59 ± 31 (range: 28-132 months) versus 46 ± 33.1 (range: 7-206 months) for groups A and B respectively (p = 0.22). Gender, age, peri- and postoperative complication rates, and clinical success were comparable between the two groups. The median operative time and the console time was significantly higher in children with history of STING (op time: 142.5 ± 27.4 versus 120 ± 24.9 min (p = 0.008), console time: 117.5 ± 28.2 versus 100 ± 24.5 min (p = 0.011) for groups A and B, respectively. A total of six complications (9.2%) occurred with none of them were greater than Clavien grade 3b. The overall clinical success rate was 97%, with 2 cases of clinical failure. In both cases, VCUG demonstrated absence of VUR. DISCUSSION The outcomes of our study provided that RALUR is effective with more than 95% success rates despite failed endoscopic injection procedures. CONCLUSION The previous history of STING neither changes the success nor the complication rates of RALUR. However, this can lead to more challenging surgery by increasing the total operative times.
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Affiliation(s)
- Ilker Comez
- Memorial Hospitals Group, Urology, Istanbul; Uskudar University, Medical Faculty, Department of Urology, Istanbul, Turkey
| | - Taha Ucar
- Nigde Omer Halis Demir University Research and Training Hospital, Department of Urology, Turkey
| | - Onur Telli
- Memorial Hospitals Group, Urology, Istanbul
| | - Bilal Gunaydin
- Nigde Omer Halis Demir University, Department of Urology, Turkey
| | - M Selcuk Silay
- Memorial Hospitals Group, Urology, Istanbul; Biruni University, Department of Urology, Istanbul, Turkey.
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Chandrasekharam VVS, Ravula S, Janapareddy KK. Transvesicoscopic Ureteral Reimplantation for Primary Vesicoureteral Reflux in Children: Does Prior Failed Endoscopic Injection Impact Outcome? J Laparoendosc Adv Surg Tech A 2023; 33:417-421. [PMID: 36921282 DOI: 10.1089/lap.2022.0556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Purpose: Transvesicoscopic ureteral reimplantation (TVUR) for vesicoureteral reflux (VUR) is a technically demanding operation. The technical difficulty is further increased by previous failed endoscopic injection, which causes intense fibrosis around the ureter. In this study, we compared primary TVUR with TVUR after previous failed endoscopic injection for VUR. Materials and Methods: The records of all children undergoing TVUR by a single surgeon over a 4-year period were analyzed. The children were divided into group 1 (primary TVUR, n = 50) and group 2 (TVUR after previous failed endoscopic treatment of Dextranomer/Hyaluronic Acid, n = 7). Demographic, clinical, radiologic, operative and follow-up data were compared between the two groups. The results were analyzed by statistical software; Mann-Whitney test and Fisher's exact test were used where appropriate, and P < .05 was considered significant. Results: Both the groups were comparable with respect to age and mean VUR grade. The mean VUR grade was significantly higher in group 1 and mean operative time per ureter was significantly more for group 2 than group 1. The postoperative hospital stay, success of TVUR, and complications were not significantly different between the groups. Conclusions: To our knowledge, this is the first report of its kind. TVUR after previous failed endoscopic injection could be done safely with good success, but with longer operative time than primary TVUR even in expert hands. Hence, previous failed endoscopic injection is not a contraindication to TVUR.
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Affiliation(s)
- V V S Chandrasekharam
- Pediatric Surgery, Pediatric Urology and MAS, FSPU, Ankura Hospitals for Women and Children, Little Star Children's Hospital, Hyderabad, Telangana, India
| | - Satyanarayana Ravula
- Department of Pediatric Surgery, Ankura Hospitals for Women and Children, Hyderabad, Telangana, India
| | - Khyati Kiran Janapareddy
- Department of Pediatric Surgery, Ankura Hospitals for Women and Children, Hyderabad, Telangana, India
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Ureteral reimplantation after deflux failure for vesicoureteral reflux in renal transplant. World J Urol 2021; 40:271-276. [PMID: 34415373 DOI: 10.1007/s00345-021-03814-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To evaluate the outcomes of ureteral reimplantation (UR) after failure of endoscopic treatment for symptomatic vesicoureteral reflux (VUR) in renal transplant recipients. METHODS We conducted a monocentric retrospective study that included all renal transplant recipients with failure of Deflux™ as first-line treatment of VUR from January 2007 to December 2020. Failure of Deflux™ was defined by: VUR on retrograde cystography and at least one acute pyelonephritis of the renal graft. The preferred surgical treatment was native ureteropyelostomy (NPUS) in the recent years. If the native ureter could not be used, ureteroneocystostomy (UNC) was performed. The primary outcome was the clinical efficacy of UR defined as the absence of acute graft pyelonephritis during follow-up. RESULTS Out of 1565 kidney transplantations, 119 (7.6%) had symptomatic VUR treated with bulking agent. 35 (29.4%) had Deflux™ failure and were addressed to UR: 21/35 (60%) NPUS and 14/35 (40%) UNC. The median estimated blood loss, operative time, and length of stay were 120 mL, 90 min, and 7 days, respectively. After a median follow-up of 7.1 (IQR 4.1-9.8) years, UR was clinically successful in a total of 32 patients (91.4%): 20 (95.2%) and 12 (85.7%) patients in the NPUS and UNC groups, respectively (p = 0.55). Three (8.5%) high-grade complications have been reported. No nephrectomy of native kidney was required in the NPUS group. CONCLUSIONS After failure of Deflux™ for VUR of renal graft, surgical treatment with native ureteropyelostomy or ureteroneocystostomy is associated to a high success rate and few high-grade complications.
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Janssen KM, Kirsch AJ. Outcomes of complex robot-assisted laparoscopic ureteral reimplantation after failed ipsilateral endoscopic treatment of vesicoureteral reflux. J Pediatr Urol 2021; 17:547.e1-547.e6. [PMID: 34274237 DOI: 10.1016/j.jpurol.2021.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Endoscopic injection (EI) has been considered a minimally invasive option with high success rates. However, in clinical settings where EI has failed, and after repeat injections or worsening clinical presentation, different treatment modalities may be offered. Open ureteral reimplantation has emerged as a safe option in patients who have failed EI for VUR treatment. Currently there is limited literature describing success of complex robot-assisted laparoscopic ureteral reimplantation (RALUR) following primary EI for vesicoureteral reflux (VUR). OBJECTIVE We aim to describe our surgical technique and outcomes using RALUR approach following failed EI for VUR. We hypothesize RALUR can be a safe, salvage option in patients who have failed EI for VUR in the setting of recurrent VUR or ureterovesical junction obstruction (UVJO). METHODS A single site, retrospective study using electronic medical records of all patients who underwent RALUR between 2013 and 2019 following history of previous ipsilateral EI using dextranomer/hyaluronic acid (DHA) for diagnosis of vesicoureteral reflux (VUR) was conducted. Primary outcomes were radiographic resolution and/or clinical resolution. RESULTS A total of 17 RALUR procedures were reviewed in 16 patients. There were 14 females (87.5%) and 2 males (12.5%). Seven patients had two prior EI. Median (range) age at time of RALUR was 10.1 (5.7-17.9) years, and the average time between EI and RALUR was 5.9 years [1-13]. The average VUR recurrence grade after failed EI was 3 (ranges 2-4) on preoperative VCUG. History of bilateral EI using dextranomer/hyaluronic acid (DHA), was observed in 14 patients. Surgical diagnosis at time of RALUR included persistent VUR (N = 10) or symptomatic ureterovesical junction obstruction (UVJO, N = 6). Mean console times were 102 min (range 70-240 min) for RALUR vs 128 min (range 70-180 min) for cases requiring ureteral tailoring. Six complications occurred in 16 patients (37.6%): Using the Clavien-Dindo classification scale, four patients (25%) were grade I, one (6.3%) grade II, and one (6.3%) was grade IIIb, which required additional procedures for ureteral obstruction. CONCLUSION RALUR after failed EI should be considered a reasonably safe and effective surgical approach in older children with persistent VUR or acquired UVJO.
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Affiliation(s)
- Karmon M Janssen
- From Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Andrew J Kirsch
- From Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
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Burki T, Howeiti MS, Almadhi MK, Al Modhen FM, Alhazmi H, Vallasciani SA, Alhams AE, Mehmood SW, Al Shammari AM. Outcome of salvage ureteral reimplantation after endoscopic treatment failure for high-grade vesicoureteral reflux compared to primary ureteral reimplantation. Urol Ann 2019; 12:49-53. [PMID: 32015617 PMCID: PMC6978971 DOI: 10.4103/ua.ua_58_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 10/13/2019] [Indexed: 11/04/2022] Open
Abstract
Introduction Surgical treatment of vesicoureteral reflux is required after conservative treatment has failed. However, there is a controversy if fibrosis related to previous attempts of dextranomer/hyaluronic acid (Dx/Ha) injection increases the risk of surgical difficulty and postoperative complications. Therefore, the purpose of our study was to compare the outcome of salvage ureteral reimplantation (SUR), after failed endoscopic therapy, to that of primary ureteral reimplantation in patients with high-grade primary vesicoureteral reflux (VUR). Materials and Methods We conducted a retrospective analysis of children, <14 years old, treated for Grade IV or V VUR, between 1998 and 2014. Cases were classified into the SUR or the PUR group. Cases of secondary VUR were excluded. All patients were treated using a cross-trigonal ureteral reimplantation technique by two surgeons. The following demographic and clinical variables were included in the analysis: presentation, reflux severity, scarring on imaging, age at endoscopic injection, total amount of Dx/Ha injected, operative time, postoperative hospital stay, operative complications, incidence of febrile urinary tract infections (UTIs) after surgery, and persistent VUR. Between the groups, differences were evaluated using Fisher's exact test. Results Twenty-six patients were included, 19 in the SUR and 7 in the primary ureteral reimplantation (PUR) group. In the SUR group, 12 cases had a bilateral VUR and 7 had a unilateral VUR, with 4 bilateral and 3 unilateral VUR cases in the PUR group. In the SUR group, 13 patients had received one Dx/Ha injections, with the other 6 receiving two injections, of 0.5 ml of Dx/Ha (range, 0.5-2.0 ml). A bilateral reimplantation was performed in 14/19 patients in the SUR group and 4/7 in the PUR group. The median age at surgery was 4 years in the SUR group and 3 years in the PUR group (P < 0.02). The median operative time was comparable between the groups (120 and 140 min for the SUR and PUR groups, respectively, P = 0.73), with a comparable length of hospital stay (5 and 6 days, respectively, P = 0.061). Blood loss was generally <10 ml, except in three cases in the SUR group, due to difficult dissection. Over the median follow-up of 1 year, persistent Grade III SUR was identified in only one patient in the SUR group, with no occurrence of febrile UTIs postoperatively. Conclusion SUR for high-grade primary VUR after failed Dx/Ha injection has the same success rate as PUR, with no significant complication rate, although the necessary dissection may be more difficult.
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Affiliation(s)
- Tariq Burki
- Pediatric Urology Division, King Abdullah Specialized Children Hospital, King Abdul Aziz Medical City, National Guard Health Affair, Riyadh, KSA
| | - Muhammad S Howeiti
- Pediatric Urology Division, King Abdullah Specialized Children Hospital, King Abdul Aziz Medical City, National Guard Health Affair, Riyadh, KSA
| | - Maha K Almadhi
- Division of Pediatric Urology, Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, KSA
| | - Fayez M Al Modhen
- Pediatric Urology Division, King Abdullah Specialized Children Hospital, King Abdul Aziz Medical City, National Guard Health Affair, Riyadh, KSA
| | - Hamdan Alhazmi
- Division of Urology, Department of Surgery, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, KSA
| | - Santiago A Vallasciani
- Division of Pediatric Urology, Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, KSA.,Alfaisal University, School of Medicine, Riyadh, KSA
| | - Abdulwahab E Alhams
- Pediatric Urology Division, King Abdullah Specialized Children Hospital, King Abdul Aziz Medical City, National Guard Health Affair, Riyadh, KSA
| | - Shahbaz W Mehmood
- Department of Urology, King Faisal Specialist Hospital and Research Center Riyadh, KSA
| | - Ahmed M Al Shammari
- Pediatric Urology Division, King Abdullah Specialized Children Hospital, King Abdul Aziz Medical City, National Guard Health Affair, Riyadh, KSA
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Çitamak B, Bozaci AC, Altan M, Haberal HB, Kahraman O, Ceylan T, Doğan HS, Tekgül S. Surgical outcome of patients with vesicoureteral reflux from a single institution in reference to the ESPU guidelines: a retrospective analysis. J Pediatr Urol 2019; 15:73.e1-73.e6. [PMID: 30472078 DOI: 10.1016/j.jpurol.2018.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/20/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Vesicoureteral reflux (VUR) is an anatomic or functional disorder, and it is a condition associated with renal scarring, hypertension, and end-stage renal disease. Renal damage can be prevented by appropriate medical and surgical intervention for selected patients. OBJECTIVES The objective of this study was to retrospectively analyze the surgically treated patient group of this study in reference to the risk analysis criteria used in European Association of Urology (EAU), European Society for Paediatric Urology (ESPU) guidelines to see the outcome of the study management protocol within the last 15 years in respect to this risk analysis. STUDY DESIGN A total of 686 patients who were operated upon in a single institution for VUR between 1997 and 2016 were retrospectively analyzed. According to the criteria in EAU/ESPU guidelines, the patients were classified into three groups: low, medium, and high risk. Risk factors were compared between the groups. RESULTS The patient numbers for low, medium, and high risk were 92 (13.4%), 485 (70.7%), and 109 (15.9%), respectively. In the high-risk group, surgeons tended to do more ureteroneocystostomy (UNC) (82.6%), whereas in the low-risk group, surgeons tended to do more subureteric injection (STING) (76.1%). The success rates for STING and UNC were found to be 75% and 93%, respectively. Although there was a difference in success rates among patients treated with STING or UNC, this difference was not statistically significant in success rates regarding risk groups for patients treated with STING or UNC. DISCUSSION The most recent guideline was that which was published by the EAU/ESPU organization in 2012. This guideline is established based on the risk analysis. The analysis revealed that patients in the low-risk group tended to undergo endoscopic surgery treatment method, whereas patients in the high-risk group tended to undergo open surgery. Therefore, the study management over the last 10 years has been mainly in line with the current recommendations. CONCLUSION The analysis shows that when the patients are classified according to the EAU/ESPU risk classification, surgeons tended to perform more endoscopic and more open surgery for the low- and high-risk groups, respectively. Although each surgical modality had similar success rates in each group, open surgical results were overall much higher than those of endoscopic surgery in each group. This was a specifically important finding in high-risk group where the endoscopically treated group of patients was small in number, and the need for a definitive correction is essential in this group because of increased risk of renal injury.
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Affiliation(s)
- B Çitamak
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey.
| | - A C Bozaci
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - M Altan
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - H B Haberal
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - O Kahraman
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - T Ceylan
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - H S Doğan
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - S Tekgül
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
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Friedlander DA, Ludwig WW, Jayman JR, Akhavan A. The effect of prior endoscopic correction of vesicoureteral reflux on open ureteral reimplantation: Surgical outcomes and costs. J Pediatr Urol 2018. [PMID: 29534861 DOI: 10.1016/j.jpurol.2018.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Endoscopic injection of a bulking agent is a common first-line approach to the treatment of vesicoureteral reflux (VUR). While early outcomes are comparable to open ureteroneocystotomy, 5-25% of children will eventually develop recurrent reflux necessitating repeat injections or open ureteral reimplantation. OBJECTIVE To determine whether prior endoscopic injection of a bulking agent impacts outcomes of subsequent open ureteral reimplantation. STUDY DESIGN Using a retrospective cohort design, radiographic and clinical outcomes of open ureteral reimplantation were compared between patients with and without prior endoscopic correction of reflux. Surgical and hospitalization data were also compared between groups and a cost comparison was performed to assess differences in healthcare costs between the two cohorts. Units of analysis included total ureters or total patients. For certain variables, subanalysis of unilateral versus bilateral reimplantation was included. RESULTS A total of 258 patients underwent open reimplantation for VUR between 2007 and 2016 by five pediatric urologists. Final analysis (see Summary Table) included 192 patients with pre-operative and postoperative voiding cystourethrogram (VCUG) and follow-up data at a median 4.95 months. Among 317 reimplanted refluxing ureters, radiographic resolution was reached in 26/27 (96.3%) patients with and 279/290 (96.2%) without prior endoscopic treatment (P = 0.981). Clinical success was achieved in 17/17 (100%) patients with and 174/175 (99.4%) without prior endoscopic treatment (P = 0.755). There were no statistically significant differences between duration of surgery or length of hospital stay. There were no statistically significant differences between total charges, total costs, and operating room (OR) costs between groups. DISCUSSION This study indicated that prior endoscopic injection of a bulking agent did not impact the outcomes or costs of subsequent open ureteroneocystotomy. While prior studies have demonstrated tissue changes associated with injection of a bulking agent, these did not seem to significantly impact the difficulty of later open surgery or the success rates compared to patients who proceeded directly to open correction of reflux. CONCLUSION Open ureteral reimplantation for recurrent VUR after failed endoscopic injection of a bulking agent was safe and effective, with comparable outcomes and costs to open surgery in patients without prior endoscopic correction.
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Affiliation(s)
- D A Friedlander
- Division of Pediatric Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - W W Ludwig
- Division of Pediatric Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J R Jayman
- Division of Pediatric Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Akhavan
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
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Kajbafzadeh AM, Sabetkish S, Khorramirouz R, Sabetkish N. Comparison of histopathological characteristics of polyacrylate polyalcohol copolymer with dextranomer/hyaluronic acid after injection beneath the bladder mucosa layer: a rabbit model. Int Urol Nephrol 2017; 49:747-752. [PMID: 28210914 DOI: 10.1007/s11255-017-1540-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 02/08/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To compare short- and long-term local tissue reaction of polyacrylate polyalcohol copolymer (PPC) with dextranomer/hyaluronic acid (DHA) in rabbits. METHODS Eight healthy New Zealand rabbits were randomly divided into two groups. In group I (control group), DHA was injected just beneath the mucosal layer of the bladder wall, while PPC was injected in group II. Subcutaneous injection of both bulking agents was also performed in nude mice. Histological evaluations with leukocyte common antibody (LCA), CD68, CD31, and CD34 were conducted on biopsies 1 and 6 months postoperatively. Scanning electron microscopy (SEM) and MTT assay were also performed for these two bulking agents. RESULTS SEM images revealed larger particle size of PPC. LCA and CD68 staining was significantly higher in group II as compared with group I in both short- and long-term follow-ups. However, in groups I and II, expression of CD31 (101 ± 0.5 vs. 92 ± 0.25, p > 0.05) and CD34 (115 ± 0.75 vs. 103 ± 0.5, p > 0.05) was not significantly different in long-term follow-up. Remarkably, severe fibrosis was observed in group II as compared to mild fibrosis in group I one month after injection. The results of in vivo application of these bulking agents in nude mice were in accordance with the results obtained from rabbit model. MTT assay revealed that cell proliferation was significantly higher in the presence of DHA as compared with PPC. CONCLUSION Severe inflammation and fibrosis in PPC may be due to continued foreign body reaction, presence of alcohol polymers, or larger particle sizes.
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Affiliation(s)
- Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Qarib's St, Keshavarz Blvd, Tehran, 4194 33151, Iran.
| | - Shabnam Sabetkish
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Qarib's St, Keshavarz Blvd, Tehran, 4194 33151, Iran
| | - Reza Khorramirouz
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Qarib's St, Keshavarz Blvd, Tehran, 4194 33151, Iran
| | - Nastaran Sabetkish
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Qarib's St, Keshavarz Blvd, Tehran, 4194 33151, Iran
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Karakus SC, User İR, Kılıc BD, Akçaer V, Ceylan H, Ozokutan BH. The comparison of dextranomer/hyaluronic acid and polyacrylate-polyalcohol copolymers in endoscopic treatment of vesicoureteral reflux. J Pediatr Surg 2016; 51:1496-500. [PMID: 27061353 DOI: 10.1016/j.jpedsurg.2016.02.092] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 02/24/2016] [Accepted: 02/25/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dextranomer/hyaluronic acid (Dx/Ha;Dexell®) and polyacrylate-polyalcohol copolymer (PPC;Vantris®) are the popular tissue-augmenting substances using for the endoscopic injections of vesicoureteral reflux (VUR). The aim of the study is to evaluate and compare Dx/Ha and PPC in terms of effectiveness, injection techniques and complications with special emphasis on vesicoureteral junction obstruction (VUJO). METHODS A total of 95 patients who underwent endoscopic VUR treatment between 2009 and 2015 were retrospectively reviewed. The patients were divided into two groups: group 1: Patients underwent endoscopic treatment with PPC (n=50 patients, 70 renal refluxing units) group 2: Patients underwent endoscopic treatment with Dx/Ha (n=45 patients, 74 renal refluxing units). RESULTS The overall resolution rates based on the number of renal refluxing units studied was 88.6% and 70.3% in group 1 and group 2, respectively. Resolution rates were significantly better in group 1 compared to group 2. VUJO requiring ureteral reimplantation or stent insertion developed in 7 patients in group 1. No VUJO was observed in group 2. VUJO in group 1 was markedly higher than that in group 2. CONCLUSIONS Endoscopic treatment of VUR with PPC promises better resolution rates but higher VUJO rates compared to Dx/Ha.
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Affiliation(s)
- Suleyman Cuneyt Karakus
- University of Gaziantep, Faculty of Medicine, Department of Pediatric Surgery, Gaziantep, Turkey.
| | - İdil Rana User
- University of Gaziantep, Faculty of Medicine, Department of Pediatric Surgery, Gaziantep, Turkey
| | | | - Vedat Akçaer
- University of Gaziantep, Faculty of Medicine, Department of Pediatric Surgery, Gaziantep, Turkey
| | - Haluk Ceylan
- University of Gaziantep, Faculty of Medicine, Department of Pediatric Surgery, Gaziantep, Turkey
| | - Bulent Hayri Ozokutan
- University of Gaziantep, Faculty of Medicine, Department of Pediatric Surgery, Gaziantep, Turkey
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Lee S, Jeong SC, Chung JM, Lee SD. Secondary surgery for vesicoureteral reflux after failed endoscopic injection: Comparison to primary surgery. Investig Clin Urol 2016; 57:58-62. [PMID: 26966727 PMCID: PMC4778758 DOI: 10.4111/icu.2016.57.1.58] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 12/24/2015] [Indexed: 11/18/2022] Open
Abstract
PURPOSE As endoscopic treatment for vesicoureteral reflux (VUR) has increased, secondary ureteral reimplantation (UR) after failure of endoscopic treatment has increased. We studied the clinical feature and efficacy of secondary UR after failure of endoscopic treatment compared with primary UR. MATERIALS AND METHODS Eighty-one children who had UR for VUR were enrolled. Charts were reviewed retrospectively for age, sex, grade of VUR before surgery, operative time, hospitalization period, postoperative complication, and success rate. Primary UR (group A, n=64) was compared with secondary UR after failed endoscopic treatment (group B, n=17). In group B, telephone survey for the satisfaction of endoscopic treatment and surgery was done. RESULTS Mean age of each group was 49.6±37.1 and 56.6±22.5 months (p=0.236). There was no significant difference between each group in sex, mean operative time, postoperative transfusion, complication rate, and success rate. As telephone survey in group B, eleven responders preferred endoscopic treatment as primary treatment of VUR because it was a simple method and no hospitalization. CONCLUSIONS Secondary UR after failure of endoscopic treatment was similar to primary UR. Parents preferred endoscopic treatment as first line treatment for VUR in spite of the need for secondary UR after failure of endoscopic treatment.
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Affiliation(s)
- Seungsoo Lee
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seung Chan Jeong
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jae Min Chung
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sang Don Lee
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
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