Endoscopic management of vesicoureteral reflux secondary to myelomeningocele in children: a single-center experience
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ORIGINAL RESEARCH
Endoscopic management of vesicoureteral reflux secondary to myelomeningocele in children: a single‑center experience Saeed Alhindi1 · Mohamed Mubarak1 · Husain Alaradi1 Received: 30 June 2020 / Revised: 5 September 2020 / Accepted: 19 September 2020 © Springer Nature Singapore Pte Ltd 2020
Abstract Background Vesicoureteral reflux (VUR) is present in up to 24% of children with neurogenic bladder secondary to meningomyelocele. Endoscopic management of VUR has been an emerging approach, especially since the continuous development of this technique has translated in comparatively high success rates. In this study, we assess the efficacy of subureteric injections of dextranomer/hyaluronic acid copolymer in managing VUR secondary to meningomyelocele in pediatric patients. Materials and methods All patients aged less than 12 years who underwent endoscopic management for secondary VUR of grades III–V due to meningomyelocele were observed. The diagnosis and classification of VUR was done via a MCUG. All patients underwent clinical assessment, renal function tests, urine microscopy with culture, KUB ultrasound, and dimercaptosuccinic acid (DMSA) scan before and after the intervention. Results A total of 19 children (38 renal units) were evaluated and followed up. The mean age at presentation and intervention was 44 ± 34.6 months and 45.7 ± 35.2 months. The most common grade of reflux at presentation was grade IV (42.1%) followed by V (26.3%). A complete symptomatic relief and treatment success was achieved in 29 renal units (76.3%) following a single injection. A second injection was sufficient to achieve symptomatic relief in the remaining nine renal units (23.6%). None of the patients required a third injection or open surgery. Conclusion The endoscopic treatment of secondary VUR grades III, IV, and V due to meningomyelocele with dextranomer/ hyaluronic copolymer paste in children younger than 12 years is safe and effective alternative minimally invasive surgery with low morbidity. Keywords Hydronephrosis · Neurogenic bladder · Vesicoureteral reflux
Introduction Vesicoureteral reflux (VUR) is the most common urological anomaly in pediatric patients and occurs in around 1–9% of all children and up to 50% of children presenting with UTI [1]. It occurs either due to a defective ureterovesical junction (UVJ) or due to pressure discrepancies in the bladder against a normal UVJ secondary to bladder dysfunction. Furthermore, it is present in approximately one-third of patients with neurogenic bladder dysfunction [2]. In fact, the incidence of VUR in patients born with meningomyelocele ranges from 0 to 24% with the risk of increasing up to 60% with inadequate management [3]. The management * Mohamed Mubarak [email protected] 1
Department of Surgery, Salmaniya Medical Complex, P.O. Box 12, Manama, Bahrain
of VUR secondary to neurogenic bladder could be done via either a conservative or surgical approach. The main principle of management revolves around sustaining acceptable bladder pressures and th
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