ESPU Congress 2018 - Abstract Book

CONGRESS OF THE ESPU

08:25–08:28

S4-2 (PP)

COMPARATIVE EVALUATION OF ENDOSCOPIC

TREATMENT FOR HIGH GRADE VESICOURETERAL

REFLUX IN CHILDREN USING HYALURONIC ACID

COPOLYMER (URODEX) AND POLYACRYLATE-

POLYALCOHOL COPOLYMER (VANTRIS)

Dmitry SHAKHNOVSKIY, Eranui BARSEGYAN and Sergei ZORKIN

National Medical Research Center of Children's Health, Urology, Moscow, RUSSIAN FEDERATION

PURPOSE

To date, endoscopic injection of bulking agents is a worldwide accepted first line option for treatment

of all VUR grades due to it's minimal invasiveness and high success rate. The goal of this study

was to evaluate an efficiency of endoscopic correction for high grade VUR using Vantris and Urodex

bulking agents.

MATERIAL AND METHODS

From 2011 to 2016 a total of 199 children (86 boys and 113 girls) with a mean age of 2.1 years

(range 7 months – 6,3 years) were treated endoscopically with Urodex and Vantris injection. In the

study were included patients with only primary nonsyndromic VUR with grades IV–V. It was unilat-

eral in 72 and bilateral in 127 patients, comprising 296 renal refluxing units (RRUs). We employed

a single (STING/HIT1) injection technique for polymer insufflation. Results were evaluated using

voiding cystouretrography after 6–8 months. Positive outcome we considered to be a complete

elimination of reflux after a single injection.

RESULTS

148 children (223 RRUs) were treated using Urodex with a mean volume of bulking agent

1,6±0,3 ml. VUR resolution rate was 53,4 % after first injection. 51 children (73 RRUs) were treated

using Vantris with a mean volume of bulking agent 0,35±0,15 ml. VUR resolution rate was 75,6 %

after first injection. Vantris was found to be more effective than Urodex (Pearson χ

26,28, p=95 %).

Vesicoureteral junction obstruction, requiring stent insertion, developed in 4 ureters in Vantris group

(5,5 %). Six patients in both groups (3 %) developed febrile urinary tract infection.

CONCLUSIONS

Results of this study confirm that endoscopic correction of VUR using Urodex and Vantris bulk-

ing agents is an effective procedure for treating high grades of VUR. In single injection technique

Vantris is more effective thаn Urodex, but the possibility of late ureteral obstruction has to be taken

into account employing Vantris bulking agent.

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Discussion