Endoscopic injection vs anti-reflux surgery for moderate- and high-grade vesicoureteral reflux in children: a cost-effectiveness international study.
Humans
Vesico-Ureteral Reflux
/ surgery
Male
Female
Retrospective Studies
Child, Preschool
Child
Cost-Benefit Analysis
Infant
Robotic Surgical Procedures
/ economics
Treatment Outcome
Adolescent
Length of Stay
Replantation
/ economics
Ureter
/ surgery
Operative Time
Laparoscopy
/ methods
Endoscopy
/ methods
Hyaluronic Acid
/ administration & dosage
Injections
Dextrans
/ administration & dosage
Costs
Endoscopic injection
Radiation exposure
Success rate
Ureteral reimplantation
Vesicoureteral reflux
Journal
Journal of robotic surgery
ISSN: 1863-2491
Titre abrégé: J Robot Surg
Pays: England
ID NLM: 101300401
Informations de publication
Date de publication:
16 Oct 2024
16 Oct 2024
Historique:
received:
16
08
2024
accepted:
14
09
2024
medline:
16
10
2024
pubmed:
16
10
2024
entrez:
16
10
2024
Statut:
epublish
Résumé
Even if vesicoureteral reflux is a common condition in children, there are no guidelines about the best therapeutic approach. This study aims to compare the results of endoscopic injection and ureteral reimplantation in children with grade III, IV and V VUR. A multicenter retrospective study included children with grade III, IV and V VUR treated from 2003 to 2018 at three Departments of Pediatric Surgery. Patients were divided into Group A (endoscopic injections) and Group B (anti-reflux surgery), B1 (open, OUR), B2 (laparoscopic, LUR) and B3 (robot-assisted laparoscopic RALUR). Follow-up was at least 5 years. 400 patients were included, 232 (58%) in group A and 168 (42%) in group B. Mean age at surgery was 38.6 months [3.1-218.7]. Mean follow-up was 177.8 months [60-240]. Group A had shorter operative time than group B (P < 0.01); lower analgesic requirement (p < 0.05), shorter hospital stay (P < 0.05) and lower overall costs (p < 0.05), but higher postoperative PNPs (p < 0.01), lower success rate (p < 0.01) and higher redo-surgery percentage (p < 0.01). No differences in terms of postoperative complications, success rate and mean radiation exposure between the two groups. Endoscopy is associated with shorter operative time, shorter hospitalization and lower cost, also in case of multiple injections. Recurrence rate after surgery is lower meaning lower rate of re-hospitalization and radiation exposure for children.
Identifiants
pubmed: 39412617
doi: 10.1007/s11701-024-02103-5
pii: 10.1007/s11701-024-02103-5
doi:
Substances chimiques
Hyaluronic Acid
9004-61-9
Dextrans
0
Types de publication
Journal Article
Multicenter Study
Comparative Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
371Informations de copyright
© 2024. The Author(s).
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