PURPOSE: To evaluate the efficacy of subureteral injection types in patients with middle- to high-grade vesicoureteral reflux (VUR). MATERIALS AND METHODS: Between June 1999 and September 2010, subureteral dextranomer was applied at our clinic to 149 patients (214 refluxing ureters) with grades II, III, and IV VUR. Group 1 consisted of 54 patients (80 ureters), and group 2 consisted of 95 patients (134 ureters). The standard subureteric transurethral injection (STING) procedure was applied to group 1, and the modified STING procedure was applied to group 2. A second and if needed a third injection was applied to unsuccessfully treated patients. The mean follow-up period was 2 years. Patients were evaluated by cystography and ultrasonography in the third month of follow-up. RESULTS: VUR was resolved completely after a single injection in 54/80 ureters (67.5%) in group 1 and in 94/134 ureters (70.1%) in group 2. Overall successes after a second or a third injection were 61/80 (76.2%) and 111/134 (82.8%), respectively. There was a statistically significant difference between the groups only for grade IV reflux following multiple injections (p<0.05). CONCLUSIONS: Endoscopic treatment of VUR is a recommended treatment because it is minimally invasive, efficient, and repeatable. Our study confirmed that a modified STING procedure can be an alternative treatment to the standard technique.
Administration, Intravesical ; Adolescent ; Child ; Child, Preschool ; Dextrans/*administration & dosage ; Endoscopy ; Female ; Follow-Up Studies ; Humans ; Hyaluronic Acid/*administration & dosage ; Infant ; Male ; Reproducibility of Results ; Treatment Outcome ; Ureter/*surgery ; Urologic Surgical Procedures/*methods ; Vesico-Ureteral Reflux/*drug therapy/ultrasonography

PURPOSE: To evaluate the efficacy of subureteral injection types in patients with middle- to high-grade vesicoureteral reflux (VUR). MATERIALS AND METHODS: Between June 1999 and September 2010, subureteral dextranomer was applied at our clinic to 149 patients (214 refluxing ureters) with grades II, III, and IV VUR. Group 1 consisted of 54 patients (80 ureters), and group 2 consisted of 95 patients (134 ureters). The standard subureteric transurethral injection (STING) procedure was applied to group 1, and the modified STING procedure was applied to group 2. A second and if needed a third injection was applied to unsuccessfully treated patients. The mean follow-up period was 2 years. Patients were evaluated by cystography and ultrasonography in the third month of follow-up. RESULTS: VUR was resolved completely after a single injection in 54/80 ureters (67.5%) in group 1 and in 94/134 ureters (70.1%) in group 2. Overall successes after a second or a third injection were 61/80 (76.2%) and 111/134 (82.8%), respectively. There was a statistically significant difference between the groups only for grade IV reflux following multiple injections (p<0.05). CONCLUSIONS: Endoscopic treatment of VUR is a recommended treatment because it is minimally invasive, efficient, and repeatable. Our study confirmed that a modified STING procedure can be an alternative treatment to the standard technique.
Administration, Intravesical ; Adolescent ; Child ; Child, Preschool ; Dextrans/*administration & dosage ; Endoscopy ; Female ; Follow-Up Studies ; Humans ; Hyaluronic Acid/*administration & dosage ; Infant ; Male ; Reproducibility of Results ; Treatment Outcome ; Ureter/*surgery ; Urologic Surgical Procedures/*methods ; Vesico-Ureteral Reflux/*drug therapy/ultrasonography

No abstract available.
Dextrans/*therapeutic use ; Female ; Humans ; Hyaluronic Acid/*therapeutic use ; Male ; Urinary Tract Infections/*epidemiology ; Vesico-Ureteral Reflux/*drug therapy

We aimed to investigate the clinical value of persistent but downgraded vesicoureteral reflux (VUR) after dextranomer/hyaluronic acid (Dx/HA) injection in children. The medical records of 128 children (195 ureters) who underwent Dx/HA injections for VUR were reviewed. The incidences of pre- and post-operative febrile urinary tract infections (UTIs) were analyzed in children with or without persistent VUR on voiding cystourethrography (VCUG) 3 months postoperatively. The surgical results of VUR persistent children who underwent a single additional injection were assessed. The VUR resolved completely in 100 ureters (51.3%), was persistent in 95 ureters, and newly developed in 2 ureters. The incidence of pre/post-operative febrile UTIs were 0.35 +/- 0.39 per year and 0.07 +/- 0.32 per year in VUR resolved children (P < 0.001), and 0.76 +/- 1.18 per year and 0.20 +/- 0.61 per year in VUR persistent children (P < 0.001). A single additional Dx/HA injection (44 ureters) resolved VUR in 29 ureters (65.9%), and also reduced the VUR to grade I in 7 ureters (15.9%), II in 4 (9.1%), and III in 4 (9.1%). Even in children with persistent VUR after Dx/HA injection, the incidence of febrile UTIs decreased markedly. The VUR grade significantly decreases after single additional Dx/HA injection.
Antibiotic Prophylaxis ; Child ; Child, Preschool ; Dextrans/*therapeutic use ; Female ; Fever/complications/epidemiology ; Humans ; Hyaluronic Acid/*therapeutic use ; Incidence ; Male ; Retrospective Studies ; Treatment Outcome ; Urinary Tract Infections/complications/drug therapy/*epidemiology ; Vesico-Ureteral Reflux/*drug therapy/surgery

PURPOSE: Many pediatric urologists still favor using prophylactic antibiotics to treat children with vesicoureteral reflux (VUR). However, breakthrough infection sometimes occurs, leading to significant increases in morbidity as a result of renal scarring. Therefore, we tested whether abnormal renal scan and other factors are predictive of breakthrough infection using univariate analyses. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 163 consecutive children who were diagnosed with vesicoureteral reflux between November 1997 and June 2010. Clinical parameters for the statistical analysis included form of presentation, gender, age, VUR grade, laterality, presence of intrarenal reflux, class of antibiotic drug, and presence of abnormal renal scan by Dimercapto-succinic acid. Clinical parameters used for prognostic factors were established by univariate analyses. Fisher's exact test and unpaired t-test were done using SPSS software [SPSS ver. 12.0 (SPSS Inc., Chicago, IL, USA)]. RESULTS: Breakthrough infection developed in 61 children (48.0%). A total of 58 children (45.7%) had abnormal renal scans. Time to development of breakthrough infection was significantly longer in girls (9.0+/-8.2 months) than in boys (5.8+/-4.8 months, p<0.05). On univariate analysis, though statistically not significant, the most predictive factor of breakthrough infection was abnormal renal scan (p=0.062). In patients with abnormal renal scans, breakthrough infection was not associated with mode of presentation, gender, grade or prophylactic antibiotics. However, there was a significant difference between patients younger than 1 year and those 1 year old or older. Mean+/-SD age at diagnosis of VUR in patients with breakthrough infection (1.14+/-3.14) was significantly younger than in those without breakthrough infection (5.05+/-3.31, p=0.009). There was also a significant difference between patients with bilateral or unilateral reflux (p=0.028). CONCLUSION: Our data showed that abnormal renal scan was the most predictive factor of breakthrough infection and demonstrated statistical significance in patients under the age of 1 year. Parents and physicians should remain aware that these patients are at high risk of breakthrough urinary tract infection, which may potentially lead to renal damage.
Anti-Bacterial Agents/*therapeutic use ; Female ; Humans ; Infant ; Male ; Retrospective Studies ; Urinary Tract Infections/*drug therapy/etiology ; Vesico-Ureteral Reflux/complications/*drug therapy/*microbiology

OBJECTIVETo analyze the relationship between the prognosis and clinical factors of primary vesicoureteral reflux (VUR) patients under the condition of non-surgical treatment.

METHODThe medical records of the patients who were diagnosed as VUR by micturating cystourethrography (MCU) from January 2000 to December 2009 in Children's Hospital of Fudan University underwent non-surgical treatment, and followed up for more than one year then had repeated MCU, were retrospectively reviewed.

RESULTA total of 73 children (30 boys, 43 girls) were included in this study. The percentage of mild reflux (grade I-II) was 19.2% (14/73), that of moderate reflux (grade III) was 53.4% (39/73), and that of severe reflux (grade IV-V) was 27.4% (20/73). Among 73 patients, 27 (37.0%) patients were found to have renal damage. The average interval of repeated MCU was (1.29 ± 0.40) years (1 - 2 years). After follow-up, it was found that the reflux grade was relieved in 41 (56.2%) patients, of whom 27 (37.0%) patients achieved complete resolution, 32 (43.8%) patients did not have remission in reflux grade, of whom 13 (17.8%) patients had worsened reflux grade. Logistic regression analysis showed that VUR patients with renal damage at initial diagnosis was an important clinical factor to affect reflux remission (P = 0.000), complete resolving (P = 0.008) and result in worsening (P = 0.002).

CONCLUSIONA certain proportion of primary VUR patients could get reflux grade self-resolution, it was also quite common in severe VUR patients. VUR patients with renal damage at initial diagnosis was an important clinical factor affecting the reflux grade prognosis. Mild and moderate VUR patients with renal damage were at risk of worsening. VUR patients with high reflux grade had normal renal status could still get remission or even disappearance of VUR. But severe VUR patients with renal damage were still recommended to receive surgical therapy.

Anti-Bacterial Agents ; administration & dosage ; therapeutic use ; Child ; Child, Preschool ; Cicatrix ; Female ; Humans ; Infant ; Kidney Diseases ; epidemiology ; etiology ; pathology ; Male ; Prognosis ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Survival Rate ; Urinary Tract Infections ; epidemiology ; etiology ; prevention & control ; Urography ; Vesico-Ureteral Reflux ; complications ; drug therapy ; pathology

OBJECTIVE: Endoscopic correction of vesicoureteral reflux has evolved as a viable alternative to open surgery. This study was conducted to review the experience of a single institution with the endoscopic Deflux procedure and assess its effectiveness in the treatment of vesicoureteral reflux.

MATERIALS AND METHODS: A retrospective review of patients who underwent endoscopic Deflux treatment for primary vesicoureteral reflux (VUR) between January 2005 and December 2010 was performed. Data collected included: age, gender, unilateral or bilateral treatment, pre-operative grade of VUR on voiding cystourethrogram (VCUG), and the number of Deflux injections per patient.

RESULTS: Sixteen patients [7 (43.75%) males and 9 (56.25%) females] were included in this study. The ages ranged from 6 months to 8 years old with a mean age of 3.15 years. Four (25%) patients had bilateral VUR while 12 (75%) had unilateral VUR, with a total of 21 refluxing ureters. Three had Grade II reflux (14.3%), 13 had Grade III reflux (62%), 5 had Grade IV reflux (24%), and 1 had Grade V reflux (4.7%). Nineteen ureters required one injection while one ureter required two injections. There were no intraoperative nor postoperative complications noted.

CONCLUSION: At the National Kidney and Transplant Institute, endoscopic treatment of VUR with Deflux for primary VUR demonstrated a cure rate of 90%, with no associated perioperative morbidity.

Human ; Male ; Female ; Child ; Child Preschool ; Infant ; deflux ; Endoscopy ; Vesico-Ureteral Reflux-treatment, therapy, management, drug therapy ; Urinary Bladder Diseases ; dextranomer ; dextranomer-hyaluronic acid copolymer

OBJECTIVES: The Hinman Syndrome is a condition representing urinary voiding dysfunction in a neurologically intact child. This syndrome probably is an acquired behavioral and psychosocial disorders. We present a case presenting voiding dysfuntion with no neurologic etiology. CASE: The department of urology consulted the department of psychiatry for a psychiatric evaluation of a 14-year-old girl with a history of recurrent urinary tract infections, enuresis, and urinary dribbling since early childhood. She visited the emergency room because of severe abdominal pain and hematuria. She was admitted to the department of urology. Neurological tests showed no abnormality, but a retrograde cystogram showed free vesicoureteral reflux to the level of the dilated intrarenal collecting systems. Marked blunting and dilatation of the calices suggested longstanding urinary flow obstruction. She had a history of separation anxiety disorder and was very competetive, perfectionistic, and nervous. She also had very poor relationships with her friends and had difficulties in managing them. After admission, she had stent operation and cystostomy. Antidepressant and anxiolytic medications with supportive psychotherapy were administered to treat anxiety, tension and depression. Gradually, her depressive symptoms and voiding difficulties improved. CONCLUSIONS: Psychological factors such as a perfectionistic and obsessive personality, a history of severe separation anxiety, stressors from poor interpersonal relationships and the failure of an entrance examination seem to have contributes to the development and exacerbation of the urinary dysfunction. Pharmacotherapy and supportive psychotherapy may be effective in treating associated psychiatric problems of these patients with hinman syndrome.
Abdominal Pain ; Adolescent ; Anxiety ; Anxiety, Separation ; Child ; Cystostomy ; Depression ; Dilatation ; Drug Therapy ; Emergency Service, Hospital ; Enuresis ; Female ; Friends ; Hematuria ; Humans ; Psychology ; Psychotherapy ; Stents ; Urinary Tract Infections ; Urology ; Vesico-Ureteral Reflux

PURPOSE: The development of contralateral reflux after successful unilateral antireflux surgery has led to controversy regarding etiology. Our aim was to analyze the incidence of newly developed contralateral reflux after successful unilateral Cohen's reimplantation in patients with grade III and IV reflux and to explain the postoperative trigonal distortion responsible for new contralateral reflux with case-control study. MATERIALS AND METHODS: We compared the incidence and outcome of contralateral reflux between the medical group with prophylactic antibiotics and the surgical group with unilateral Cohen's reimplantation in patients with unilateral vesicoureteral reflux. We retrospectively reviewed the records of 84 children seen in a 17-year period who had grade III (48 patients) and IV (36 patients) primary unilateral vesicoureteral reflux. Unilateral Cohen's reimplantation was done in 48 patients and prophylactic chemotherapy was done in 36 patients. RESULTS: Overall contralateral reflux developed in 13.8% of patients who underwent medical treatment and 14.6% of patients who underwent unilateral Cohen's reimplantation. In patients with grade III reflux, 13% of patients with medical treatment and 12% of patients with unilateral Cohen's reimplantation had contralateral reflux. Twelve patients with contralateral reflux had grade I (7 patients) and grade II (5 patients) reflux and resolved spontaneously within 18.2 months. CONCLUSIONS: The likelihood of trigonal distortion as the etiology of contralateral reflux is low given the similar incidence in cross-trigonal Cohen's reimplantation group and medical group with prophylactic chemotherapy in patients with grade III and IV primary vesicourerteral reflux.
Anti-Bacterial Agents ; Case-Control Studies* ; Child ; Drug Therapy ; Humans ; Incidence ; Replantation* ; Retrospective Studies ; Vesico-Ureteral Reflux*

Since 1991 the orthotopic ileocolic neobladder after radical cystoprostatectomy for bladder cancer has been performed at our hospital. We report our 5 year experience of ileocolic neobladder with focus on complications, urodynamic data and continence status. Between May 1991 and April 1996, a total of 49 men underwent bladder replacement with an orthotopic ileocolic neobladder following radical cystectomy for management of invasive bladder cancer. Mean age of the patient .was 53.2 years (range 34-68) Mean follow up was 42 months (range 4-63). There was one perioperative death due to sepsis who had been suffered from diabetes mellitus. Early complications were developed in 8 patients (16.7%); neobladder leak in 1 (2.1%), wound infection in 2 (4.2%), wound dehiscence in 2 (4.2%), prolonged ileus in 1 (2.1%), and pneumonia in 1 (2.1%). Neobladder-related late complications requiring rehospitalization were noted in 7 patients (14.6%); cecourethral anastomosis site stricture in 1 (2.1%) which was treated endoscopically, ureteral strictures at the reimplantation site in 5 (7 renal unites, 10.4%) which were successfully treated with balloon dilation in 4 patients and with open revision in 1 patient, and neobladder perforation in 1 (2.1%) which was managed conservatively without sequelae. Urethral recurrence was noted in 1 patient and has been managed with M-VAC chemotherapy. There was no. vesicoureteral reflux in any patient. Urodynamic study of the neobladder at 6 months showed a low pressure (mean 24.2 cm H2O), large capacity (mean 553 ml) and an adequate maximal urethral closure pressure (mean 51.3 cmH2O). The peak flow rate in all patients was good (mean 11.3m/sec). All patients were dry during daytime but mild stress urinary incontinence was noted in 5 patients (10.4%) and nighttime continence was good in 91.7% at 6 months. Our results indicate that orthotopic ileocolic neobladder provides good functional results and would be one of the ideal urinary diversion for bladder substitution after radical cystoprostatectomy and will continue to be our procedure of choice in selected male bladder cancer patients.
Constriction, Pathologic ; Cystectomy ; Diabetes Mellitus ; Drug Therapy ; Follow-Up Studies ; Humans ; Ileus ; Male* ; Pneumonia ; Recurrence ; Replantation ; Sepsis ; Ureter ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Urinary Diversion ; Urinary Incontinence ; Urodynamics ; Vesico-Ureteral Reflux ; Wound Infection ; Wounds and Injuries