ESPU Congress 2018 - Abstract Book

11–14 APRIL, 2018, HELSINKI, FINLAND

08:34–08:37

S4-3 (PP)

RESULTS OF A NEW TECHNIQUE ADDRESSING LATE OBSTRUCTIONS AFTER

ENDOSCOPIC TREATMENT OF VESICOURETERAL REFLUX

Vitaly DUBROV

, Vladimir SIZONOV

, Nail AKRAMOV

, Dmitry SABLIN

and

Ilia KAGANTSOV

1) 2

Pediatric Hospital, Pediatric urology, Minsk, BELARUS - 2) Regional Children's Hospital, Paediatric Urology,

Rostov On Don, RUSSIAN FEDERATION - 3) Children's Republican Clinical Hospital of The Ministry of Health of The

Republic Of Tatarstan, Paediatric Urology, Kazan, RUSSIAN FEDERATION - 4) Arkhangelsk regional children's clinical

hospital P.G. Vyzhletsov, Pediatric urologist, Arkhangelsk, RUSSIAN FEDERATION - 5) Syktyvkar State University

named after Pitirim Sorokin, Pediatric urology, Syktyvkar, RUSSIAN FEDERATION

PURPOSE

Late obstructions (LO) belong to the most severe complications after endoscopic treatment of

vesicoureteral reflux (VUR). Ureteral reimplantation is the most popular and efficient method of LO

elimination. We analyzed the results of LO elimination by means of transurethral implantectomy

accomplished through dissected bladder mucosa.

MATERIAL AND METHODS

During the recent 20 years, 4115 endoscopic VUR corrections were performed in 5 hospitals. LO

were revealed in 27 cases. In 9 patients with post-STING mound formed inside the bladder, the

obstruction was removed using transurethral dissection of the bladder mucosa above the implant,

fragmentation of the latter and its evacuation from the bladder. Average age of the patients was

41±19 months (6 girls and 3 boys). Average reflux grade was 3,4. Unilateral VUR – 4 children,

bilateral in 5 patients. LO was formed following the first endoscopic treatment in 6 cases, in 3 chil-

dren – after the second implant injection. In 5 children a copolymer of polyacrylate-polyvinyl alcohol

was used for the implant, in 4 – a dextranomer/hyaluronic acid based bulking agent. In 7 cases an

ureteral stent was inserted. A follow-up examination took place after stent extraction (in 2 months),

in 6 months ultrasonography, diuretic renography (DR) and micturating cystography (MC) were

performed.

RESULTS

In 8 cases implant evacuation after transurethral mucosa incision was successful. One patient had

a damaged wall of the intravesical ureter and therefore ureteral reimplantation was performed.

In 2 months following the surgery a pronounced reduction of pelvicalyceal dilatation was noted

in 7 children after the stent extraction and one child without drainage. In 6 months 6 patients

were examined; according to the MC results, no reflux was found, DR returned no data indicating

obstruction.

CONCLUSIONS

Transurethral mucosa dissection and evacuation of intravesicular implant is an efficient alternative

to ureter reimplantation in LO cases.