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RESEARCH PRODUCT

Intraoperative ultrasound-assisted approach for endoscopic treatment of vesicoureteral reflux in children

Elisa ZambaitiCasuccio AlessandraMarcello CimadorMaria SergioSergio Salerno

subject

Malemedicine.medical_specialtyVoiding cystourethrogramEndoscopic injection030232 urology & nephrologyPediatricsVesicoureteral refluxIntraoperative ultrasound03 medical and health sciences0302 clinical medicinemedicineHumansEndoscopic injection; Endoscopic treatment; Intraoperative ultrasound; Vesicoureteral reflux; Pediatrics Perinatology and Child Health; SurgeryPostoperative PeriodAntibiotic prophylaxisChildPreschoolUltrasonographyVesico-Ureteral RefluxIntraoperative ultrasoundEndoscopic injection; Endoscopic treatment; Intraoperative ultrasound; Vesicoureteral reflux; Child; Child Preschool; Endoscopy; Female; Humans; Male; Postoperative Period; ROC Curve; Treatment Outcome; Ultrasonography; Vesico-Ureteral Reflux; Surgery; Pediatrics Perinatology and Child Healthmedicine.diagnostic_testbusiness.industryVesicoureteral refluxRefluxEndoscopic treatmentEndoscopyGeneral MedicinePerioperativePerinatology and Child Healthmedicine.diseaseSurgeryEndoscopyTreatment OutcomeROC CurveChild Preschool030220 oncology & carcinogenesisPediatrics Perinatology and Child HealthFemaleSurgeryRadiologybusinessEndoscopic treatment

description

Purpose Despite minimal invasiveness and high success rate, guidelines still prescribe voiding Cystourethrogram (VCUG) after endoscopic treatment for vesicoureteral reflux (VUR) in children. The aim of this paper was to analyze whether intraoperative ultrasound (IO-US) could improve surgical accuracy and perioperative counseling, thus potentially decreasing the need for postoperative VCUG. Methods We selected children treated for moderate to high grade VUR, renal scarring or repeated infections under antibiotic prophylaxis from January to December 2015. Endoscopic injection was combined with IO-US to detect optimal needle placement and to guide mound formation. IO-US findings were compared to surgeon opinion and postoperative VCUG, performed 3 months after surgery. All patients were followed-up for 1 year. Results A significant relationship was found between IO-US mound height (p = 0.003) or localization (p < 0.0005) and VCUG. Success of endoscopic treatment vs persistence of reflux groups had a mean mound height of 10.62 ± 1.36 mm and 8.39 ± 1.08 mm respectively (p < 0.0005). Height maintained a significant correlation with success in simple and multivariable regression analysis. ROC curve determined ≥ 9.8 mm as predictor of reflux resolution (95% CI 0.825 to 0.998; p < 0.0001). Conclusions IO-US facilitates pediatric urologists to find an optimal location, to reach a volcano mound morphology and height, thus increasing intraoperative accuracy. IO-US also helps evaluating high-risk recurrence and guiding prognostic counseling. Type of study Treatment study. Level of evidence II.

yearjournalcountryeditionlanguage
2017-01-01
10.1016/j.jpedsurg.2017.04.004http://www.elsevier.com/inca/publications/store/6/2/3/1/4/8/index.htt