Intraoperative ultrasound-assisted endoscopic treatment of primary intermediate and high-grade vesicoureteral reflux in children in a long-term follow-up.

Bulking agents Children Endoscopy Intraoperative ultrasound Vesicoureteric reflux

Journal

Journal of pediatric urology
ISSN: 1873-4898
Titre abrégé: J Pediatr Urol
Pays: England
ID NLM: 101233150

Informations de publication

Date de publication:
14 Oct 2023
Historique:
received: 02 06 2023
revised: 04 10 2023
accepted: 09 10 2023
medline: 26 10 2023
pubmed: 26 10 2023
entrez: 25 10 2023
Statut: aheadofprint

Résumé

Endoscopic treatment of vesicoureteral reflux (VUR) is an important minimally invasive surgical approach in patients undergoing surgical treatment of VUR. In our past experience, we observed that a bulking agent mound sagittal diameter of 10 mm is the main predictor of effectiveness of the procedure. Moreover we noticed that the use of intraoperative ultrasound, allows the surgeon to better identify the site, volume and shape of the bulking agent injected, finally reducing operative time. We aimed to evaluate if the intraoperative ultrasound assistance could definitively improve effectiveness of the endoscopic procedure. We retrospectively compared two series treated with endoscopic procedures for intermediate and high grade primary VUR, respectively without (series A) and with (series B) intraoperative ultrasound (IO-US). In all patients VCUG was performed to assess VUR grade and to verify resolution or VUR downgrading during the follow-up. A total of 177 ureteric units were treated. Endoscopic procedures globally were effective in 68/96 ureters (70.8 %) in series A and in 68/81 ureters (83.9 %) in series B. No significant differences in effectiveness were observed comparing the series with regard to VUR grades, but a significant difference is shown (p < 0.05) when grouping grades III-V VUR. No significance in differences of volume injected were detected, but operative time was significantly lower in series B (27.5 min vs 19.6 min, p < 0.05). Mean sagittal mound diameter measured during cystoscopy in series B was 10.45 mm (range 8.5-14.2 mm). The intraoperative ultrasound assistance during endoscopic treatment of VUR could represent a valid tool for surgeons to better identify location, volume and shape of the bulking agent. Furthermore, the use of an objective parameter of evaluation of the implant can overcome the subjective intraoperative evaluation of the implant itself, improving results for experienced surgeons and reducing the learning-curve for inexperienced ones. Results of endoscopic injection of bulking-agent can be improved with intraoperative ultrasound, allowing at the same time a significant reduction of operative time.

Sections du résumé

BACKGROUND BACKGROUND
Endoscopic treatment of vesicoureteral reflux (VUR) is an important minimally invasive surgical approach in patients undergoing surgical treatment of VUR. In our past experience, we observed that a bulking agent mound sagittal diameter of 10 mm is the main predictor of effectiveness of the procedure. Moreover we noticed that the use of intraoperative ultrasound, allows the surgeon to better identify the site, volume and shape of the bulking agent injected, finally reducing operative time.
OBJECTIVE OBJECTIVE
We aimed to evaluate if the intraoperative ultrasound assistance could definitively improve effectiveness of the endoscopic procedure.
METHODS METHODS
We retrospectively compared two series treated with endoscopic procedures for intermediate and high grade primary VUR, respectively without (series A) and with (series B) intraoperative ultrasound (IO-US). In all patients VCUG was performed to assess VUR grade and to verify resolution or VUR downgrading during the follow-up.
RESULTS RESULTS
A total of 177 ureteric units were treated. Endoscopic procedures globally were effective in 68/96 ureters (70.8 %) in series A and in 68/81 ureters (83.9 %) in series B. No significant differences in effectiveness were observed comparing the series with regard to VUR grades, but a significant difference is shown (p < 0.05) when grouping grades III-V VUR. No significance in differences of volume injected were detected, but operative time was significantly lower in series B (27.5 min vs 19.6 min, p < 0.05). Mean sagittal mound diameter measured during cystoscopy in series B was 10.45 mm (range 8.5-14.2 mm).
DISCUSSION CONCLUSIONS
The intraoperative ultrasound assistance during endoscopic treatment of VUR could represent a valid tool for surgeons to better identify location, volume and shape of the bulking agent. Furthermore, the use of an objective parameter of evaluation of the implant can overcome the subjective intraoperative evaluation of the implant itself, improving results for experienced surgeons and reducing the learning-curve for inexperienced ones.
CONCLUSIONS CONCLUSIONS
Results of endoscopic injection of bulking-agent can be improved with intraoperative ultrasound, allowing at the same time a significant reduction of operative time.

Identifiants

DOI: 10.1016/j.jpurol.2023.10.008 PMID: 37880015
pubmed: 37880015
pii: S1477-5131(23)00435-7
doi: 10.1016/j.jpurol.2023.10.008
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Déclaration de conflit d'intérêts

Conflict of Interest None.

Auteurs

Pensabene M (P)

Paediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo PA, Italy. Electronic address: marco.pensabene@policlinico.pa.it.

Cimador M (C)

Paediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo PA, Italy.

Spataro B (S)

Paediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo PA, Italy.

Serra G (S)

Neonatal Intensive Care Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy.

Baldanza F (B)

Paediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo PA, Italy.

Grasso F (G)

Paediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo PA, Italy.

Corsello G (C)

Neonatal Intensive Care Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy.

Salerno S (S)

Department of Biopathology and Medical Biotechnology, Section of Radiological Sciences, DIBIMED - University of Palermo, Via del Vespro 127, 90127, Palermo, Italy.

Di Pace Mr (DP)

Paediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo PA, Italy.

Sergio M (S)

Paediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo PA, Italy.

Classifications MeSH