Risk factors for obstruction following endoscopic correction for vesicoureteral reflux in children
Having a high reflux grade, inflamed bladder mucosa and an obstructive/refluxing megaureter are all risk factors for ureterovesical junction (UVJ) obstruction following endoscopic correction of vesicoureteral reflux (VUR) in children, a new study has shown.
Researchers retrospectively evaluated 2,495 children who underwent endoscopic correction for VUR. The two tissue-augmenting substances used were Deflux or Vantris. For controls, they used nine primary obstructive megaureters after ureteral reimplantation.
Eighteen of the participating children (median age 2.5 years; 10 male) developed UVJ obstruction requiring reimplantation, half of whom were initially treated with Vantris. Mean time to obstruction development was 16 months after endoscopic correction.
Initial statistical analysis showed that rate of obstruction development was higher in patients treated with Vantris. However, after subsequent adjustments, statistical significance was attenuated.
Moreover, univariate Mann-Whitney and Fisher tests identified a grade V reflux, the presence of a narrowed distal ureter and an inflamed bladder mucosa as independent risk factors for obstruction in both treatment groups.
In terms of patient presentation, more than half (n=10; 55.6 percent) of those who developed obstructions were symptomatic, complaining of flank pain. The remaining eight patients developed asymptomatic hydronephrosis. Most of the children (n=15; 83.3 percent) required only a single injection in order to cure reflux while the other three patients required two injections.
The findings suggest that patients with high-grade VUR should be properly counselled before undergoing surgery and informed of the possible risk of UVJ obstruction, said researchers.