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19–22 APRIL, 2017, BARCELONA, SPAIN
CONCLUSIONS
The use of appropriate instruments, such very small open-end ureteric catheter for UVJ negotiation
and larger 6 fr balloon catheter for UVJ dilatation, can improve feasibility of EHPBD in over 90% of
patients with POM requiring treatment.
11:36–11:48
Discussion
S23-8 (P without presentation)
SECONDARY VESICOURETERAL REFLUX AFTER
SUCCESSFUL ENDOUROLOGICAL TREATMENT
OF PRIMARY OBSTRUCTIVE MEGAURETER
Luis GARCIA-APARICIO
1
, Eva BLAZQUEZ-GOMEZ
2
, Oriol MARTIN
1
, Andrea SORIA
1
and Sonia PEREZ-BERTOLEZ
1
1) Hospital Sant Joan de Déu. University of Barcelona, Pediatric Urology Division. Pediatric Surgery Department,
Barcelona, SPAIN - 2) Hospital Sant Joan de Déu. University of Barcelona, Anaesthesiology Department, Barcelona,
SPAIN
PURPOSE
To describe the incidence, predisposing factors and management os secondary vesicoureteral
reflux (sVUR) after endourological treatment of primary obstructive megaureter (POM).
MATERIAL AND METHODS
We have reviewed all medical charts of patients that underwent endourological treatment of POM
from 2008 until 2015. Preoperatively, all patients were evaluated with ultrasound scan (US), voiding
cystourethrography (VCUG), and MAG-3 diuretic renography. Endourological treatment was done
with high-pressure balloon dilation (HPBD) of the ureterovesical junction; a double-J stenting was
done in all patients. After 2 months, double-J was removed. Follow-up was peformed with US,
VCUG and MAG-3 diuretic renography. VCUG were performed after 6 months of HPBD.
RESULTS
Twenty seven patients with a mean age of 16.4 months were reviewed. A total of 29 ureters were
treated. After HBPD, ureterohydronephrosis improved in 24 ureters (82.8%), this improvement was
evaluated with US and MAG-3 diuretic renography. After successful treatment of POM, 8/24 ureters
developed sVUR (33.3%).
In the first 4 refluxing ureters a successful surgical management was performed (2 reimplantation
and 2 endoscopic treatment with Dx/HA). But in the following 4 cases a conservative management
was proposed with antibiotic prophylaxis; the evolution was unventful and after 6 months of starting
antibiotic prophylaxis a VCUG was performed. sVUR dissapeared in all patients.
Urinary tract infection after succesful treatment of POM was observed in 4 patiens, but only two of
them were affected with sVUR. UTI was not related with the presence of sVUR (p<0.05).
The presence of parameatal diverticula in the preoperative VCUG and those patients with bilateral
POM are risk factors related with sVUR after HPBD.
CONCLUSIONS
The incidence of sVUR after successful endourological treatment of POM is high. Conservative
management of sVUR could be the first treament of choice if patient is asymptomatic, because
there is a high rate of resolution.