DOI: 10.1177/10926429261479314 ISSN: 1092-6429

Minimally Invasive Management for Unilateral Vesicoureteral Reflux: Comparison of Endoscopic Injection Versus Transvesicoscopic Cohen Reimplantation

Keerthika Murali, VVS Chandrasekharam
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Objective:

Surgical intervention techniques to correct unilateral vesicoureteral reflux (VUR) are advocated to prevent recurrent urinary tract infections and further renal damage. Although unilateral ureteral reimplantation is highly successful, new contralateral reflux (NCVUR) can develop postoperatively in some patients. The purpose of this study was to review and analyse the outcomes of Endoscopic injection of dextranomer/hyaluronic acid (ET) and transvesicoscopic Cohen ureteral reimplantation (TVUR) in unilateral VUR, along with incidence and clinical outcomes of NCVUR.

Methods:

After IRB approval, the data of children that underwent ET (group 1) and TVUR (group 2) for unilateral VUR over a 6-year period was reviewed. Children with secondary and bilateral VUR, duplex kidneys, and no postoperative follow-up were excluded. Various parameters were compared between the two groups.

Results:

Ninety-eight children (42 group 1 and 56 group 2) were included. The mean grade of VUR was significantly higher in group 2 than group 1 ( P < .001). Group 1 had significantly shorter operating time and hospital stay than group 2 ( P = .0001), while group 2 had higher success ( P = .007), although the clinical efficacy for grades 2 to 3 VUR was comparable in both groups. The overall incidence of NCVUR was 6%, with no significant difference between the groups ( P = .715). During a mean follow-up of 36 months, all NCVUR were managed by observation only, with no renal damage or need for surgical intervention.

Conclusions:

TVUR was preferred by parents for higher grades of VUR with paraureteral diverticulum and had higher success. ET had lower morbidity, and for grades 2–3 VUR, ET and TVUR had comparable clinical efficacy. The overall incidence of NCVUR was low, with no increased risk of NCVUR after TVUR, and most NCVUR was benign and self-limiting.

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