[Endoscopic treatment of complicated vesicoureteral reflux grades III-V in infants under the age of one year]. / Tratamiento endoscópico del reflujo vesico ureteral III-V complicado en lactantes menores de 1 año.

OBJECTIVES: Our aim is to know the results of Endoscopic Treatment (ET) in infants with recurrent pyelonephritis and high grade (G) Vesicoureteral Reflux (VUR). INCLUSION CRITERIA: infants 2-12 months old with G III-V VUR and at least 2 pyelonephritis, one of them during antibiotic prophylaxis (AP). N = 27 infants: 19 males (70%) and 8 females. VUR was primary in 17 (63%) and secondary in 10. VUR Grade was III in 12 ureters (U) (32%), IV 16 (42%) and V 10 (26%). Polydimethylsiloxane, Hydroxiapatite and Dextranomer/ Hyaluronic Acid (DAH) were the bulking agents employed. Results Classification: Solved: G 0-I.; Improved: G II (control without AP); Persistence: III-V Open Surgery (OS) or repeated ET (1-2) was done depending on cystoscopic findings. RESULTS: 34 ureters are available for final results; 1 G III, 2 G IV and 1 G V are waiting for a new injection. G III 11 U: 11 first and 4 second injections (1.36 Injections / ureter): Solved 9 (81.8%), Improved 1, OS 1 (9%). G IV 14 U: 14 first 3 second and 1 third injection (1.28 injections / ureter): Solved 10 (71.4%), Improved 4. No OS. G V 9 U: 9 first, 4 second and 1 third injections (1.55 injections / ureter): Solved 5 (55.6%), Improved 1, OS 3 (33.3%). Overall results: Solved: 24 U (70.58%), Improved: 6 (17.6%), OS 4 (11.8%). OS avoided 30 (88.2%): G III 91%, IV 100% and V 66.7%. Results of G III are better than G V. The only complication was 1 ureteral obstruction treated successfully with open surgery. CONCLUSIONS: ET can be considered the first therapeutic option in infants with G III-V VUR and pyelonephritis in spite of PA, because ET has solved VUR in 70.58% and avoided OS in 88.2% with a minimally invasive procedure and low incidence of complications.

[Transitory urinary retention after simultaneous bilateral extravesical ureteral reimplantation]. / Retención urinaria transitoria en el reimplante ureteral extravesical bilateral simultáneo.

OBJECTIVES: We report the outcome and incidence of urinary retention after bilateral extravesical reimplant in patients with primary vesicoureteral reflux. METHODS: We retrospectively evaluated the chart of 127 patients, 92 females and 35 males, who underwent correction of primary vesicoureteral reflux using the extravesical approach. Mean patient age at surgery was 3.93 years. Postoperatively the urethral catheter was removed after 24 to 72 hours and a voiding trial was done. Surgical outcomes were analyzed specifically for perioperative complications and resolution of reflux on postoperative VCUG. RESULTS: Mean follow-up was 4.01 years. Postoperative VCUG showed resolution of reflux in 122 (96%) patients. Urinary retention developed in 7/127 patients (5.5%). In 57 patients in whom the surgery was done from 06-1998 to 01-2001, urinary retention developed in 5/57 (8.7%) for 1 day (1), 2 days (1), 5 days (2) and 4 weeks (1). In 70 patients in whom the surgery was done from 02-2001 to 10-2006, urinary retention developed in 2/70 (2.85%) for 1 day (2). CONCLUSIONS: Bilateral extravesical vesicoureteral reimplant can be associated with temporary urinary retention. In the last 5 years, with a careful and limited dissection close to the distal ureter and used of bipolar cautery when necessary, we were able to decreased the risk of postoperative urinary retention.

[Contralateral vesicoureteral reflux after endoscopic treatment of primary unilateral reflux]. / Obstruccion ureteral postoperatoria después de antirreflujo endoscópico.

OBJECTIVES: The endoscopic treatment (ET) of vesicoureteral reflux (VUR) is considered by many urologic and pediatric surgeons as the first treatment option in the event of being required, because it is a minimally invasive procedure, of short duration, ambulatory in many cases, with good results and few complications. Ureteral obstruction is the most serious but less frequent complication. The objective is know the incidence, treatment and evolution of patients with ureteral obstruction as complication of the ET of VUR. METHODS: Evaluation of the medical literature using Pubmed and Ovid. Revision of the clinical report of children (CH) under ET of VUR between March of 1998 and July of 2007, to find those cases that presented ureteral obstruction after ET. RESULTS: A total of 377 children (CH) with VUR in 598 ureters (U), were treated with TE, during the mentioned period of 9 years, between March 1998 and July 2007. Only 2 U (0.33%), in 2 CH (0.5%) presented Ureteral Obstruction with dilatation of the upper urinary tract that need open surgical ureteral reimplantation, with good results in both patients. CONCLUSION: The risk of ureteral obstruction after ET of VUR is low, less than 0.5% of U. The treatment of this complication can be endoscópic or by open surgery both of them with good results.

[Postoperative ureteral obstruction after endoscopic antireflux therapy]. / Reflujo vesicoureteral contralateral despues del tratamiento endoscópico del reflujo unilateral primario.

OBJECTIVES: To know the incidence of new contralateral VUR and its evolution in children with primary unilateral vesicoureteral reflux (VUR) managed with endoscopic treatment (ET). METHODS: During 7.5 years a total of 228 children with primary VUR underwent endoscopic implantation of bulking material, 90 of them (39.5%) have been unilateral. The inclusion criterion was: unilateral primary VUR managed with ET, without previously contralateral VUR. Collected data included: patient age, gender, indications for surgery, number of preoperative cystourethrograms, preoperative and new contralateral postoperative VUR grades, nephropathy in the ipsilateral or contralateral sides, type and volume of bulking material used, and VUR outcome. An update bibliographic review with methanalysis is also performed to compare results. RESULTS: Six children (6.7%) developed new contralateral VUR. Mean age was 3.3 years. Four patients were females and 2 males. The bulking material used was polydimethylsiloxane in one and Dextranomer/Non animal stabilished hyaluronic acid in 5. The initial grades of primary VUR were: II in 1 case, III in 3, and IV in 2. Four patients had previous history of bladder dysfunction. The new contralateral VUR was II in 5 and III in one. In 5 patients initial VUR persisted, always of lower grade than previously, and new contralateral VUR appeared. In one patient initial VUR disappeared and appeared in the contralateral side. Five patients were reinjected and VUR was cured, except one who is waiting for a new endoscopic procedure. One patient with grade II contralateral VUR is under observation. In the metanalysis performed nine issues have been found with an incidence of 8.2%. CONCLUSION: Contralateral VUR is a relatively frequent complication in unilateral primary VUR treated by endoscopic procedures (6.7%), but not enough as to perform bilateral endoscopic treatment in all unilateral VUR. Contralateral VUR etiology is not clear but bladder dysfunction can be an important factor.