Paper Information

Title: 

ENDOSCOPIC SUBURETERIC UROCOL INJECTION IN TREATMENT OF VESICO-URETERIC REFLUX

Type: PAPER
Author(s): HABIBI ZOHREH*,KAJBAFZADEH -
 
 *
 
Name of Seminar: CONGREH ANJOMAN UROLOGY IRAN
Type of Seminar:  CONGRESS
Sponsor:  ANJOMAN OROLOGY
Date:  2005Volume 8
 
 
Abstract: 

INTRODUCTION: IN RECENT YEARS ENDOSCOPIC SUBURETERIC INJECTION OF TISSUE-AUGMENTING SUBSTANCES HAS BECOME AN ALTERNATIVE TO LONG-TERM ANTIBIOTIC PROPHYLAXIS AND OPEN SURGERY IN THE TREATMENT OF CHILDREN WITH VESICOURETERAL REFLUX.
OBJECTIVES: WE INVESTIGATED THE CLINICAL EFFECT OF SUBURETERIC INJECTION OF UROCOL FOR THE ENDOSCOPIC TREATMENT OF VESICOURETERAL REFLUX IN PEDIATRIC PATIENTS.
MATERIALS AND METHODS: DURING A PROSPECTIVE CROSS SECTIONAL STUDY BETWEEN FEB 2000 TO DEC 2002, 208 PATIENTS WITH 346 REFLUXING URETERS -WHO HAD GRADE III TO V VESICO-URETERAL REFLUX OR GRADE I AND II WITH URINARY TRACT INFECTION DESPITE ADEQUATE ANTIBIOTIC TREATMENT- UNDERWENT ENDOSCOPIC SUBURETERAL UROCOL INJECTION. FEMALE TO MALE RATIO WAS 146/62 (2.3 TO 1). MEAN AGE OF PATIENTS WAS 4.8 YEAR (1 MONTH TO 18 YEAR). REFLUX WAS UNILATERAL IN 62 PATIENTS AND BILATERAL IN 146.
UROCOL PASTE (CONTAINING 50% MICRO POROUS HYDROXYAPATITE CERAMIC SUSPENDED IN A 4% COLLAGEN GEL) WAS ADMINISTERED THROUGH AN ENDOSCOPIC PROCEDURE.
RESULTS: THE 6-MONTH VCUG SHOWED ABSENCE OR DOWNGRADING OF REFLUX IN 302 OUT OF ALL 346 URETERS (87%). IN GRADE 1, 2, 3, 4, 5, THE SUCCESS RATE WAS RESPECTIVELY 89%, 86%, 86%, 89%, 93%.
NONE OF THE PATIENTS EXPERIENCED OBSTRUCTION OR INFECTION AFTER PROCEDURE AND NO SIDE-EFFECT WAS SEEN AFTER UROCOL INJECTION.
RESULT OF ENDOSCOPIC TREATMENT WITH UROCOL IN REFLUXING URETERS ACCORDING TO REFLUX GRADE

 

GRADE OF REFLUX

CURED

IMPROVED

UNCHANGED

TOTAL

N.

%

N

%

N.

%

NO.

%

I

8

89%

0

0

1

11%

9

100%

II

105

77%

13

9%

20

14%

138

100%

III

66

68%

17

18%

13

14%

96

100%

IV

42

57%

23

32%

8

11%

73

100%

V

19

63%

9

30%

2

7%

30

100%

 

TOTAL

 

240

 

69%

 

62

 

18%

 

44

 

13%

 

346

 

100%

CONCLUSION: OUR RESULTS CONFIRM THAT ENDOSCOPIC SUBURETERIC INJECTION OF UROCOL CORRECTS REFLUX IN LARGE MAJORITY OF PATIENTS, WITH SATISFACTORY RESULTS IN ALL GRADES OF REFLUX. UROCOL IS AN IDEAL MATERIAL WHICH IS NOT ALLERGENIC, NOT INDUCE GRANULOMA FORMATION OR MIGRATION IN THE BODY. BECAUSE OF THE SIMPLICITY OF THE TECHNIQUE, RARE COMPLICATION, SHORT HOSPITALIZATION AND HIGH SUCCESS RATE, SUBURETERIC UROCOL IS A GOOD ALTERNATIVE TO OTHER TREATMENTS OF VUR.

 
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