ESPU Congress 2018 - Abstract Book

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52 29th CONGRESS OF THE ESPU
08:37–08:40
S4-4 (PP)
IF THERE IS AN INCREASE IN UVJ OBSTRUCTION DURING
LONG TERM FOLLOW AFTER ENDOSCOPIC CORRECTION
OF VUR UTILIZING VANTRIS?
Stanislav KOCHEROV1 , Sergey NIKOLAEV2, Jaber JAWDAT1 ,
Ludmila MENOVSHCHIKOVA2 , Semen KOVARSKIY2 , Tatiana SKLIAROVA2 and
Boris CHERTIN3
1) Shaare Zedek Medical Center, Pediatric Urology, Jerusalem, ISRAEL - 2) Filatov Pediatric Hospital, Pediatric Urology,
Moscow, RUSSIAN FEDERATION - 3) Shaare Zedek Medical Center, Pediatric Urology, Jerusalem, ISRAEL
PURPOSE
We present a long-term follow-up of patients who underwent VUR correction with Vantris injection
with an emphasis on UVJ obstruction and urinary tract infection.
MATERIAL AND METHODS
During 2009–2012, 157children (106 girls and 51 boys) with mean age of 4.8 ± 2.8 years (mean
± SD) underwent endoscopic correction of VUR using Vantris. VUR was unilateral in 74 patients
and bilateral in 83 comprising 240 renal reflux units (RRU). Of these, primary VUR was present in
197 RRU (82.1 %) and 43 (17.9 %) were complex cases. 126 (80.3 %) had Breakthrough febrile
UTI and in 32 (19.7 %) patients reflux was diagnosed due to antenatal hydronephrosis. Median
follow-up was 6 years (range 5–8 years).
RESULTS
Reflux was corrected in 222 RRU (92.5 %) after a single injection, after the second injection in
10 RRU (4.2 %). In RRU 7 (2.9 %), reflux downgraded to Grade I and II, and they were taken
off antibiotic prophylaxis. One patient (0.4 %) failed endoscopic correction and required ureteral
reimplantation (UR). 11 (4.6 %) RRU developed UVJ obstruction, of which 9 (3.8 %) required UR. In
these patients reflux was Grade III in 1 RRU, Grade IV in 3 and V in 3 RRU respectively. All patients
developed obstruction between one to two years after injection. All these ureters were injected with
an average of 1.2 ml (0.6–1.8) of Vantris. 19 (12.1 %) patients developed low UTI, and 12 (7.6 %)
patients developed febrile UTI during follow up. None of these patients had reflux recurrence.
CONCLUSIONS
Our data indicate that endoscopic correction utilizing Vantris does not increase the risk of obstruc-
tion during long term follow up and significantly reduces the risk of acute pyelonephritis after suc-
cessful repair. However, the use of Vantris in patients with high-grade reflux and the injection of
a large amount of material might lead to the increased incidence of UVJ obstruction and need in
subsequent UR.