Paper Information

Title: 

COMBINED ENDOURETEROTOMY AND CA HYDROXYL APATITE STING FOR TREATMENT OF PRIMARY OBSTRUCTIVE REFLUXING MEGAURETER IN CHILDREN

Type: PAPER
Author(s): KAJBAFZADEH A.M.*,BAHAR NOURI M.
 
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Name of Seminar: CONGREH ANJOMAN UROLOGY IRAN
Type of Seminar:  CONGRESS
Sponsor:  ANJOMAN OROLOGY
Date:  2005Volume 8
 
 
Abstract: 

OBJECTIVES: MANAGEMENT OF PRIMARY OBSTRUCTIVE REFLUXING MEGAURETER “PORM” (ACCORDING TO KINGS’ CLASSIFICATION) IS NOT WELL ADDRESSED IN THE LITERATURE. THE AIM OF THIS STUDY WAS TO PRESENT THE ENDOSCOPIC MANAGEMENT OF PORM IN SYMPTOMATIC PATIENT WHICH NEEDS SURGICAL INTERVENTION. OUR PREVIOUS REPORT ON ENDOURETEOTOMY FOR PRIMARY OBSTRUCTIVE MEGAURETER IN A SMALL NUMBER OF CHILDREN WAS PROMISING. WE ARE PRESENTING THE RESULTS OF COMBINED ENDOURETEROTOMY AND ENDOSCOPIC CALCIUM APATITE (CA HA) SUBURETERIC INJECTION (STING) FOR TREATMENT OF PORM. PATIENTS AND METHODS: SIX HUNDRED AND FORTY EIGHT CHILDREN WITH VESICOURETERAL REFLUX WARRANTED SURGICAL INTERVENTION (CA HA ENDOSCOPIC STING). FROM THESE 18 CHILDREN WITH THE MEAN AGE OF 14 MONTHS (FROM 1-36 MONTHS) HAD DOCUMENTED PORM. FROM THESE 12 WERE FEMALE AND 6 MALE. ALL CHILDREN WERE PRESENTED WITH A HUGELY DILATED UNILATERAL (N=11) OR BILATERAL MEGAURETER (N=7). THE FINAL DIAGNOSIS WAS CONFIRMED FOLLOWING AN ULTRASOUND OF URINARY TRACT WITH FULL AND EMPTY BLADDER. A LASIX 99 TC DTPA SCAN WITH FULL AND EMPTY BLADDER WITH DELAYED FILMS. IN SOME CHILDREN AN INTRAVENOUS UROGRAM WAS PERFORMED BEFORE REFERRING (N=11). SEVERAL UROFLOWMETRY STUDIES WERE PERFORMED IN 7 TOILET TRAINED CHILDREN AND SHOWED NORMAL PARAMETERS. UNDER GENERAL ANESTHESIA ALL PATIENTS UNDERWENT URETEROSCOPIC ENDOURETEROTOMY WITH AN INSERTION OF A DOUBLE J STENT AND SUBURTERIC INJECTION OF CA HA AND A FOLEY BLADDER DRAINAGE FOR 24 HOURS. THE JJ STENT WAS FIXED BY A 6-0 PROLEN TO THE EXTERNAL GENITALIA AND WAS REMOVED 1 WEEK FOLLOWING THE PROCEDURE AS AN OUTPATIENT BASIS. THE PROPHYLAXIS ANTIBIOTIC WAS CONTINUED UNTIL CYSTOGRAM CONFIRMED THE COMPLETE RESOLUTION OF VUR.
RESULTS: ALL PATIENTS HAD UNEVENTFUL POSTOPERATIVE COURSE AND ALL CHILDREN WERE DISCHARGED IN THE FIRST 12 HOURS AFTER THE OPERATION. THE UPPER TRACT DILATATION WERE DISAPPEARED IN 6 MONTHS (N=7) OR 12 MONTHS AFTER SURGERY. THE VUR RESOLVED IN 13 (72.5%) AND DOWN GRADED IN 2 (11%) AND NOT CHANGED IN 3 (16.6%) IN ONE YEAR FOLLOW-UP. ONE CHILD FINALLY NEEDED TAILORING AND REIMPLANTATION AND THE REMAINING WERE CORRECTED BY REDO ENDOSCOPIC PROCEDURE. THE LOWER THIRD OF URETERS REMAIN STILL DILATED IN 50% OF PATIENTS BUT REMAINED ASYMPTOMATIC.
CONCLUSIONS: COMBINED ENDOURETEROTOMY AND SUBURETERIC INJECTION OF BULKING AGENTS IS SAFE AND HIGHLY EFFECTIVE IN TREATMENT OF PORM. THE RESULTS IS COMPARABLE TO THE OPEN SURGEY WITH LESS SURGICAL COMPLICATION AND LOWER HOSPITALIZATION IN THIS SMALL NUMBER OF PATIENTS.

 
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