| Vesicoureteral reflux(VUR)is one of the most common congenital urinary malformations.VUR has the potential to resolve without treatment.It is estimated that80% of low-grade VUR will spontaneously disappear in 5 years and 30-50% in high-grade reflux.Due to a high resolution rate,continued antibiotic prophylaxis(CAP)against breakthrough infection is a widely accepted treatment,while surgical treatment is reserved for persistent or complicated cases.Operative treatment for VUR can be divided into open and endoscopic surgery.Open surgical repair in the form of ureteric implantation has a high success rate of approximately 90-95% in elder children.However,this is technically difficult especially in infant bladder,and postoperative complications leading to prolonged hospitalization may occur.In 2010,the American Urological Association(AUA)guidelines incorporated endoscopic injection into the management of VUR as an alternative treatment option other than the conventional managements.Objective:To evaluate the outcome of paediatric patients with primary vesicoureteral reflux(VUR)and to compare continued antibiotic prophylaxis and endoscopic injection.Materials and methods:The clinical data of children diagnosed with primary vesicoureteral reflux from March 2015 to June 2020 who were treated with antibiotics or endoscopic injection were reviewed.Antibiotic was the first-line treatment after the diagnosis of VUR was established in children.It was also used to treat any febrile urinary tract infection and continued antibiotic prophylaxis(CAP)will be initiated.Endoscopic treatment consisted of injection of dextran hyaluronic acid copolymer(DX / HA)into the ureteral opening under direct cystoscopic guidance.This will re-create a submucosal tunnel to achieve an anti-reflux effect.Upon completion,the ureteral orifice would have a slit like appearance and the ureteral orifice would have a ..volcano" appearance.Result:Fifty-two children(35 males,17 females)were included in this study,and a total of 90 ureters(14 unilateral,38 bilateral)were diagnosed with vesicoureteral reflux by Voiding cystourethrography examination.Twenty-two children were treated with antibiotics(8 unilateral,14 bilateral),for a total of 36 ureters;Thirty children were treated by endoscopic injection(6 unilateral,24 bilateral),for a total of 54 ureters.The injection surgery took 36±17 minutes and the hospital stay was 2.3±1.3 days.18 male patients underwent circumcision simultaneously.There were no drug and allergic reactions in the antibiotic group,and no postoperative complications occurred in the injection group.With 23 months(13–63 months)of follow-up,the resolution rate,defined as radiological disappearance of VUR,was 36.1%(13/36)in the antibiotic group and57.4%(31 / 54)in the injection group(P=0.048).There were no surgical complications in the injection group.Two cases of bilateral reflux in the injection group required a second injection before resolution could be achieved.Thus,the overall success rate was 64.8%(35/54).Ureteral reimplantation(Cohen)was performed in 2 cases,each one in the antibiotic and injection groups,due to recurrent febrile urinary infection of persistent VUR.In DMSA scan,9 cases(9/18,50%)in the antibiotic group showed renal scars,while 20 cases(20/23,86.9%)in the injection group.There was a statistically significant difference between the two groups(P=0.010).The positive rates of ultrasound between the antibiotic group and the injection group were 45.5%(10/22)and 80.0 %(24/30),respectively.There was a statistically significant difference between the two groups in positive rates of ultrasound(P=0.010).Conclusions:1.Endoscopic injection is easy to operate with short surgical time and hospital stay,so it is a safe and feasible treatment.2.For the treatment of primary vesicoureteral reflux in children,endoscopic injection is superior to antibiotic therapy.3.In this study,the positive expression of kidney scars on DMSA and the expansion of the renal collecting system on ultrasound are the indications for endoscopic injection. |
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