Endoscopic Treatment of Vesicoureteral Reflux
نویسنده
چکیده
Primary vesicoureteral reflux (VUR) is the most common urological anomaly in children and has been reported in 30 to 50% of those who present with urinary tract infection (UTI). The association of VUR, UTI and renal parenchymal damage is well known. Reflux nephropathy is the cause of endstage renal failure in 3–25% of children and 10–15% of adults. There has been no consensus regarding when medical or surgical therapy should be used. A number of prospective studies have shown low probability of spontaneous resolution of high grade of reflux during conservative follow-up. Furthermore, all of these studies revealed that observation therapy does carry an ongoing risk of renal scarring. Open surgery is the standard treatment for VUR when indicated. Although ureteral reimplantation is effective, this operation is not free of complications. Since its introduction endoscopic correction of VUR has become an established alternative to longterm antibiotic prophylaxis and open surgical treatment. Recently, we published our data regarding long-term effectiveness of endoscopic STING (subureteral injection of polytetrafluoroethylene) for VUR in 258 patients, and its success was confirmed in our 17-year follow-up. Our study as well as long-term studies from others have not shown any clinical untoward effects with the use of polytetrafluoroethylene for the treatment of vesicoureteral reflux. Recently, a number of other tissue augmenting substances have been used endoscopically for subureteral injection. Dextranomer microspheres in sodium hyaluronic acid solution (Deflux) is a recently developed organic substance comprising 80 to 250 μm microspheres. It has been reported that dextranomer/hyaluronic acid copolymer is biodegradable, has no immunogenic properties and has no potential for malignant transformation. Dextranomer microspheres in sodium hyaluronic acid solution consist of microspheres of dextranomers mixed in a 1% high molecular weight sodium hyaluronan solution. Each millilitre of the system contains 0.5 ml sodium hyaluronan and 0.5 ml microspheres. Endoscopic Treatment of Vesicoureteral Reflux
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Treatment of pediatric vesicoureteral reflux using endoscopic injection of hyaluronic acid/dextranomer gel: intermediate-term experience by a single surgeon.
OBJECTIVES Endoscopic injection of non-animal-stabilized hyaluronic acid/dextranomer gel is an increasingly recognized treatment option for vesicoureteral reflux. The procedure is minor compared with open surgery and, when successful, avoids the need for long-term antibiotic prophylaxis. We present data from 3 years of using non-animal-stabilized hyaluronic acid/dextranomer gel to treat childre...
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Objectives: We report our experience with subureteral submucosal injection therapy for vesicoureteral reflux and determine the safety and efficacy in patients treated with dextranomer/ hyaluronic acid co-polymer. Background: Vesicoureteral reflux affects 1% of children and increases the chances of urinary tract infection, pyelonephritis, hypertension and chronic renal insufficiency. The aim of ...
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Purpose. In recent years, endoscopic injection became the procedure of choice for the correction of vesicoureteral reflux in the majority of the centers. Unfortunately, endoscopic treatment is not always successful and sometimes requires more than one trial to achieve similar results to that of an open reimplantation surgery. Our aim of this study is to evaluate the feasibility and success rate...
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