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Prem Puri - One of the best experts on this subject based on the ideXlab platform.

  • dextranomer hyaluronic acid endoscopic injection is effective in the treatment of intermediate and high grade Vesicoureteral Reflux in patients with complete duplex systems
    The Journal of Urology, 2013
    Co-Authors: Manuela Hunziker, Nochiparambil Mohanan, Prem Puri
    Abstract:

    Purpose: Endoscopic subureteral injection of dextranomer/hyaluronic acid has become an established alternative to long-term antibiotic prophylaxis or surgical treatment for Vesicoureteral Reflux. We evaluated the effectiveness of endoscopic injection of dextranomer/hyaluronic acid in intermediate and high grade Vesicoureteral Reflux in patients with complete duplex collecting systems.Materials and Methods: A total of 123 children underwent endoscopic correction of intermediate or high grade Vesicoureteral Reflux using injection of dextranomer/hyaluronic acid into complete duplex systems between 2001 and 2010. Vesicoureteral Reflux was diagnosed by voiding cystourethrogram, and dimercapto-succinic acid scan was performed to evaluate the presence of renal scarring. Followup ultrasound and voiding cystourethrogram were performed 3 months after the outpatient procedure and renal ultrasound thereafter every 2 years. Mean followup was 6.7 years.Results: Complete duplex systems were unilateral in 110 patients an...

  • single center experience with endoscopic subureteral dextranomer hyaluronic acid injection as first line treatment in 1 551 children with intermediate and high grade Vesicoureteral Reflux
    The Journal of Urology, 2012
    Co-Authors: Prem Puri, Eric Colhoun, Balazs Kutasy, Manuela Hunziker
    Abstract:

    Purpose: In recent years the endoscopic injection of dextranomer/hyaluronic acid has become an established alternative to long-term antibiotic prophylaxis and the surgical management of Vesicoureteral Reflux. We determined the safety and effectiveness of the endoscopic injection of dextranomer/hyaluronic acid as first line treatment for high grade Vesicoureteral Reflux.Materials and Methods: Between 2001 and 2010, 1,551 children (496 male, 1,055 female, median age 1.6 years) underwent endoscopic correction of intermediate and high grade Vesicoureteral Reflux using dextranomer/hyaluronic acid soon after the diagnosis of Vesicoureteral Reflux on initial voiding cystourethrogram. Vesicoureteral Reflux was unilateral in 761 children and bilateral in 790. Renal scarring was detected in 369 (26.7%) of the 1,384 patients who underwent dimercapto-succinic acid imaging. Reflux grade in the 2,341 ureters was II in 98 (4.2%), III in 1,340 (57.3%), IV in 818 (34.9%) and V in 85 (3.6%). Followup ultrasound and voiding...

  • endoscopic treatment of Vesicoureteral Reflux associated with ureterocele
    The Journal of Urology, 2007
    Co-Authors: Boris Chertin, Nochiparambil Mohanan, Amicur Farkas, Prem Puri
    Abstract:

    Purpose: We determined the value of endoscopic treatment for Vesicoureteral Reflux associated with ureterocele.Materials and Methods: From 1984 to 2005, 109 children with a median age of 6 months underwent endoscopic ureterocele puncture. Ureterocele presented as a part of a duplex system in 97 of patients (89%) and as part of a single system in 12 (11%). Vesicoureteral Reflux was seen to the lower ipsilateral moiety in 53 patients and in 32 contralateral kidneys (85 Refluxing renal units). Puncture was performed with a 3Fr Bugbee electrode. High grade Vesicoureteral Reflux or breakthrough infection while on antibiotic prophylaxis served as the indication for the surgical correction of Vesicoureteral Reflux. Median followup after endoscopic correction was 10 years (range 1 to 21).Results: Spontaneous Vesicoureteral Reflux resolution following successful ureterocele puncture was seen in 36 of the 85 Refluxing renal units (42%) and in 5 (6%) Reflux was downgraded. The latter patients were withdrawn from ant...

  • endoscopic treatment of moderate and high grade Vesicoureteral Reflux in infants using dextranomer hyaluronic acid
    The Journal of Urology, 2007
    Co-Authors: Prem Puri, Nochiparambil Mohanan, Maria Menezes, Eric Colhoun
    Abstract:

    Purpose: Renal parenchymal injury in Vesicoureteral Reflux occurs early, in most patients before age 3 years. It is generally believed that early prevention of urinary tract infections may decrease the amount of renal parenchymal damage. Endoscopic treatment for Vesicoureteral Reflux has become an established alternative to long-term antibiotic prophylaxis and ureteral reimplantation. We prospectively evaluated the effectiveness and safety of dextranomer/hyaluronic acid copolymer for high grade Vesicoureteral Reflux in infants.Materials and Methods: A total of 276 infants, including 124 boys and 152 girls, with a median age of 7 months (range 2 to 12) underwent endoscopic treatment for Vesicoureteral Reflux with dextranomer/hyaluronic acid. Reflux was detected in 225 infants following investigation for urinary tract infection, in 46 following screening for sibling Vesicoureteral Reflux and in 5 for prenatally diagnosed hydronephrosis. Vesicoureteral Reflux was unilateral in 85 infants and bilateral in 191...

  • subureteral dextranomer hyaluronic acid injection as first line treatment in the management of high grade Vesicoureteral Reflux
    The Journal of Urology, 2006
    Co-Authors: Prem Puri, Nochiparambil Mohanan, Martina A Pirker, Michal Dawrant, Laxman Dass, Eric Colhoun
    Abstract:

    Purpose: Endoscopic correction of Vesicoureteral Reflux has become an established alternative to long-term antibiotic prophylaxis and ureteral reimplantation. A number of tissue augmenting substances have been used for the endoscopic correction of Vesicoureteral Reflux. We prospectively evaluated the effectiveness of dextranomer/hyaluronic acid copolymer (Deflux®) as first line treatment for high grade Vesicoureteral Reflux.Materials and Methods: Between 2001 and 2004, 692 children with a median age of 2.1 years (3 months to 13.7 years) with high grade Vesicoureteral Reflux underwent endoscopic subureteral injection of Deflux® soon after the diagnosis of Vesicoureteral Reflux was made on the initial voiding cystourethrogram. Vesicoureteral Reflux was unilateral in 283 patients and bilateral in 409. Of the 1,101 ureters Vesicoureteral Reflux was grade II to V in 35 (3.2%), 580 (52.7%), 457 (41.5%) and 29 (2.6%), respectively. The procedure was performed on an outpatient basis. Followup ultrasound and voidi...

Andrew J. Kirsch - One of the best experts on this subject based on the ideXlab platform.

  • predicting breakthrough urinary tract infection comparative analysis of Vesicoureteral Reflux index Reflux grade and ureteral diameter ratio
    The Journal of Urology, 2020
    Co-Authors: Angela M Arlen, Christopher S Cooper, Traci Leong, Elizabeth J Traore, Andrew J. Kirsch
    Abstract:

    Purpose:The Vesicoureteral Reflux index is a simple, validated tool for predicting resolution of Reflux. Along with likelihood of spontaneous resolution identification of children at risk for febri...

  • National Trends in the Management of Primary Vesicoureteral Reflux in Children
    The Journal of urology, 2017
    Co-Authors: Michael L. Garcia-roig, Curtis Travers, Courtney Mccracken, Andrew J. Kirsch
    Abstract:

    Purpose: In September 2011 the AAP (American Academy of Pediatrics) released updated guidelines for the evaluation of children 2 to 24 months old with a febrile urinary tract infection. We documented the impact of the guideline on diagnosis and surgical management of Vesicoureteral Reflux at U.S. children’s hospitals. We hypothesized that voiding cystourethrogram studies and the Vesicoureteral Reflux treatment rate decreased concurrent with the national guideline release.Materials and Methods: The Pediatric Health Information System was queried for children (younger than 18 years) with primary Vesicoureteral Reflux and their antiReflux surgical history from January 2004 to June 2015. Voiding cystourethrogram orders were recorded. Interrupted time series analysis quantified trends surrounding several seminal Vesicoureteral Reflux publications (2007) and guideline publication (2011).Results: A total of 43,341 voiding cystourethrogram encounters (male 23,946 [55.3%]) were identified for patients at a median ...

  • multi institutional review of outcomes and complications of robot assisted laparoscopic extravesical ureteral reimplantation for treatment of primary Vesicoureteral Reflux in children
    The Journal of Urology, 2017
    Co-Authors: William R Boysen, Andrew J. Kirsch, Jonathan S Ellison, Christina Kim, Chester J Koh, Paul H Noh, Benjamin Whittam, Blake W Palmer, Aseem R Shukla, Mohan S Gundeti
    Abstract:

    Purpose: Robot-assisted laparoscopic extravesical ureteral reimplantation has been proposed as a minimally invasive alternative to open ureteral reimplantation for correcting primary Vesicoureteral Reflux in children. However, in the current literature there are conflicting data regarding the safety and efficacy of this approach. Amid ongoing debate we analyzed outcomes and complications from this procedure in a large multi-institutional cohort.Materials and Methods: We reviewed the records of children who underwent robot-assisted laparoscopic extravesical ureteral reimplantation at 9 academic centers from 2005 to 2014. Radiographic failure was defined as persistent Vesicoureteral Reflux on postoperative voiding cystourethrogram or radionuclide cystogram. Complications were graded using the Clavien-Dindo scale.Results: A total of 260 patients (363 ureters) underwent robot-assisted laparoscopic extravesical ureteral reimplantation for primary Vesicoureteral Reflux during the study period. The cohort includ...

  • appearance of dextranomer hyaluronic acid copolymer implants on computerized tomography after endoscopic treatment of Vesicoureteral Reflux in children
    The Journal of Urology, 2009
    Co-Authors: Wolfgang H. Cerwinka, Hal C. Scherz, Jing Qian, Kirk A. Easley, Andrew J. Kirsch
    Abstract:

    Purpose: With the increasing popularity of endoscopic treatment for Vesicoureteral Reflux in children, dextranomer/hyaluronic acid copolymer implants are more frequently detected on computerized tomography, which may lead to misinterpretation and unnecessary intervention. The objective of this study was to characterize the long-term appearance of dextranomer/hyaluronic acid copolymer implants on computerized tomography.Materials and Methods: We evaluated the hospital charts of 893 patients who had undergone dextranomer/hyaluronic acid copolymer injection for Vesicoureteral Reflux between July 2001 and November 2007 to identify those who underwent subsequent computerized tomography of the abdomen and pelvis. A total of 30 patients with ureterovesical junction stones served as the control group. Seven patients who proceeded to extravesical reimplantation after failed endoscopic treatment had dextranomer/hyaluronic acid copolymer implants explanted and microscopically evaluated.Results: Of 893 patients who h...

  • endoscopic therapy for Vesicoureteral Reflux a meta analysis i Reflux resolution and urinary tract infection
    The Journal of Urology, 2006
    Co-Authors: Saul P Greenfield, Andrew J. Kirsch, Martin A. Koyle, Anthony A. Caldamone, Jack S Elder, Richard S Hurwitz, Mireya Diaz, Marc Cendron, John C. Pope
    Abstract:

    Purpose: Current American Urological Association treatment guidelines for Vesicoureteral Reflux do not include any recommendations pertaining to endoscopic therapy (subureteral injection of bulking agent). We performed a meta-analysis of the existing literature pertaining to endoscopic treatment to allow comparison with reports of open surgical correction.Materials and Methods: We searched all peer reviewed articles published through 2003 pertaining to endoscopic treatment of Vesicoureteral Reflux. A total of 63 articles were double reviewed by 9 pediatric urologists, and the data were tabulated on data retrieval sheets. A mixed effects logistic regression model was used to obtain overall estimates of event probabilities (eg Reflux resolution, ureteral obstruction) together with their 95% confidence intervals. Individual study estimates were obtained with overall estimate and observation characteristics using empirical Bayes calculations. Differences between or among specific groups were assessed using th...

Jack S Elder - One of the best experts on this subject based on the ideXlab platform.

  • pediatric Vesicoureteral Reflux guidelines panel summary report clinical practice guidelines for screening siblings of children with Vesicoureteral Reflux and neonates infants with prenatal hydronephrosis
    The Journal of Urology, 2010
    Co-Authors: Steven J Skoog, Armando J. Lorenzo, Antoine E. Khoury, Hans G Pohl, Jack S Elder, Craig A Peters, Billy S Arant, Hillary L Copp, Guy R Hudson, Ellen Shapiro
    Abstract:

    Purpose: The American Urological Association established the Vesicoureteral Reflux Guideline Update Committee in July 2005 to update the management of primary Vesicoureteral Reflux in children guideline. The Panel defined the task into 5 topics pertaining to specific Vesicoureteral Reflux management issues, which correspond to the management of 3 distinct index patients and the screening of 2 distinct index patients. This report summarizes the existing evidence pertaining to screening of siblings and offspring of index patients with Vesicoureteral Reflux and infants with prenatal hydronephrosis. From this evidence clinical practice guidelines are developed to manage the clinical scenarios insofar as the data permit.Materials and Methods: The Panel searched the MEDLINE® database from 1994 to 2008 for all relevant articles dealing with the 5 chosen guideline topics. The database was reviewed and each abstract segregated into a specific topic area. Exclusions were case reports, basic science, secondary reflu...

  • summary of the aua guideline on management of primary Vesicoureteral Reflux in children
    The Journal of Urology, 2010
    Co-Authors: Craig A Peters, Armando J. Lorenzo, Antoine E. Khoury, Hans G Pohl, Jack S Elder, Billy S Arant, Steven J Skoog, Hillary L Copp, Guy R Hudson, Ellen Shapiro
    Abstract:

    Purpose: The American Urological Association established the Vesicoureteral Reflux Guideline Update Committee in July 2005 to update the management of primary Vesicoureteral Reflux in children guideline. The Panel defined the task into 5 topics pertaining to specific Vesicoureteral Reflux management issues, which correspond to the management of 3 distinct index patients and the screening of 2 distinct index patients. This report summarizes the existing evidence pertaining to children with diagnosed Reflux including those young or older than 1 year without evidence of bladder and bowel dysfunction and those older than 1 year with evidence of bladder and bowel dysfunction. From this evidence clinical practice guidelines were developed to manage the clinical scenarios insofar as the data permit.Materials and Methods: The Panel searched the MEDLINE® database from 1994 to 2008 for all relevant articles dealing with the 5 chosen guideline topics. The database was reviewed and each abstract segregated into a spe...

  • endoscopic therapy for Vesicoureteral Reflux a meta analysis i Reflux resolution and urinary tract infection
    The Journal of Urology, 2006
    Co-Authors: Saul P Greenfield, Andrew J. Kirsch, Martin A. Koyle, Anthony A. Caldamone, Jack S Elder, Richard S Hurwitz, Mireya Diaz, Marc Cendron, John C. Pope
    Abstract:

    Purpose: Current American Urological Association treatment guidelines for Vesicoureteral Reflux do not include any recommendations pertaining to endoscopic therapy (subureteral injection of bulking agent). We performed a meta-analysis of the existing literature pertaining to endoscopic treatment to allow comparison with reports of open surgical correction.Materials and Methods: We searched all peer reviewed articles published through 2003 pertaining to endoscopic treatment of Vesicoureteral Reflux. A total of 63 articles were double reviewed by 9 pediatric urologists, and the data were tabulated on data retrieval sheets. A mixed effects logistic regression model was used to obtain overall estimates of event probabilities (eg Reflux resolution, ureteral obstruction) together with their 95% confidence intervals. Individual study estimates were obtained with overall estimate and observation characteristics using empirical Bayes calculations. Differences between or among specific groups were assessed using th...

  • guidelines for consideration for surgical repair of Vesicoureteral Reflux
    Current Opinion in Urology, 2000
    Co-Authors: Jack S Elder
    Abstract:

    Vesicoureteral Reflux (VUR) is a risk factor for acute pyelonephritis, which can result in renal scarring (Reflux nephropathy), hypertension, end-stage renal disease (ESRD) and complications during pregnancy, In deciding whether to recommend surgical correction of VUR, factors that should be conside

  • pediatric Vesicoureteral Reflux guidelines panel summary report on the management of primary Vesicoureteral Reflux in children
    The Journal of Urology, 1997
    Co-Authors: Jack S Elder, Craig A Peters, Billy S Arant, David H Ewalt, Charles E Hawtrey, Richard S Hurwitz, Thomas S Parrott, Howard M Snyder, Robert A Weiss, Steven H Woolf
    Abstract:

    AbstractPurpose: The American Urological Association convened the Pediatric Vesicoureteral Reflux Guidelines Panel to analyze the literature regarding available methods for treating Vesicoureteral Reflux diagnosed following a urinary tract infection in children and to make practice policy recommendations based on the treatment outcomes data insofar as the data permit.Materials and Methods: The panel searched the MEDLINE data base for all articles from 1965 to 1994 on Vesicoureteral Reflux and systematically analyzed outcomes data for 7 treatment alternatives: 1) intermittent antibiotic therapy, 2) bladder training, 3) continuous antibiotic prophylaxis, 4) antibiotic prophylaxis and bladder training, 5) antibiotic prophylaxis, anticholinergics and bladder training, 6) open surgical repair and 7) endoscopic repair. Key outcomes identified were probability of Reflux resolution, likelihood of developing pyelonephritis and scarring, and possibility of complications of medical and surgical treatment.Results: Av...

Craig A Peters - One of the best experts on this subject based on the ideXlab platform.

  • pediatric Vesicoureteral Reflux guidelines panel summary report clinical practice guidelines for screening siblings of children with Vesicoureteral Reflux and neonates infants with prenatal hydronephrosis
    The Journal of Urology, 2010
    Co-Authors: Steven J Skoog, Armando J. Lorenzo, Antoine E. Khoury, Hans G Pohl, Jack S Elder, Craig A Peters, Billy S Arant, Hillary L Copp, Guy R Hudson, Ellen Shapiro
    Abstract:

    Purpose: The American Urological Association established the Vesicoureteral Reflux Guideline Update Committee in July 2005 to update the management of primary Vesicoureteral Reflux in children guideline. The Panel defined the task into 5 topics pertaining to specific Vesicoureteral Reflux management issues, which correspond to the management of 3 distinct index patients and the screening of 2 distinct index patients. This report summarizes the existing evidence pertaining to screening of siblings and offspring of index patients with Vesicoureteral Reflux and infants with prenatal hydronephrosis. From this evidence clinical practice guidelines are developed to manage the clinical scenarios insofar as the data permit.Materials and Methods: The Panel searched the MEDLINE® database from 1994 to 2008 for all relevant articles dealing with the 5 chosen guideline topics. The database was reviewed and each abstract segregated into a specific topic area. Exclusions were case reports, basic science, secondary reflu...

  • summary of the aua guideline on management of primary Vesicoureteral Reflux in children
    The Journal of Urology, 2010
    Co-Authors: Craig A Peters, Armando J. Lorenzo, Antoine E. Khoury, Hans G Pohl, Jack S Elder, Billy S Arant, Steven J Skoog, Hillary L Copp, Guy R Hudson, Ellen Shapiro
    Abstract:

    Purpose: The American Urological Association established the Vesicoureteral Reflux Guideline Update Committee in July 2005 to update the management of primary Vesicoureteral Reflux in children guideline. The Panel defined the task into 5 topics pertaining to specific Vesicoureteral Reflux management issues, which correspond to the management of 3 distinct index patients and the screening of 2 distinct index patients. This report summarizes the existing evidence pertaining to children with diagnosed Reflux including those young or older than 1 year without evidence of bladder and bowel dysfunction and those older than 1 year with evidence of bladder and bowel dysfunction. From this evidence clinical practice guidelines were developed to manage the clinical scenarios insofar as the data permit.Materials and Methods: The Panel searched the MEDLINE® database from 1994 to 2008 for all relevant articles dealing with the 5 chosen guideline topics. The database was reviewed and each abstract segregated into a spe...

  • Vesicoureteral Reflux associated renal damage congenital Reflux nephropathy and acquired renal scarring
    The Journal of Urology, 2010
    Co-Authors: Craig A Peters, Gil H Rushton
    Abstract:

    Purpose: The pathophysiology, evaluation, description and clinical implications of renal damage associated with Vesicoureteral Reflux remain controversial. We summarized the current understanding of this important aspect of clinical Vesicoureteral Reflux.Materials and Methods: We performed a detailed review of the literature on clinical, pathological and experimental data related to congenital Vesicoureteral Reflux and bladder dynamics. We also reviewed the clinical context and imaging evaluation with underlying experimental data related to post-infectious Reflux nephropathy.Results: Congenital Reflux nephropathy is a pattern of impaired renal function and development with renal dysplasia as the most severe but not the only form. Mechanisms of developmental disruption are potentially related to Vesicoureteral Reflux dynamics during gestation and associated bladder dynamics, which may continue into postnatal life. Acquired renal injury associated with infection is related to particular bacterial and host f...

  • nomograms for predicting annual resolution rate of primary Vesicoureteral Reflux results from 2 462 children
    The Journal of Urology, 2009
    Co-Authors: Carlos R Estrada, David A Diamond, Craig A Peters, Marc Cendron, Carlo C Passerotti, Dionne A Graham, Stuart B Bauer, Bartley G Cilento, Joseph G Borer, Caleb P Nelson
    Abstract:

    Purpose: We determined the resolution rate of Vesicoureteral Reflux and the factors that influence it to formulate nomograms to predict the probability of annual resolution for individual cases of Reflux.Materials and Methods: We studied 2,462 children with primary Vesicoureteral Reflux diagnosed between 1998 and 2006. Cox proportional hazards regression was used to model time to resolution as a function of statistically significant demographic and clinical variables. The resulting model was used to construct nomograms predicting the annual cumulative probability of Reflux resolution.Results: Multivariate analysis showed that all cases of unilateral Reflux resolved earlier than female bilateral Reflux (HR 1.42, p <0.001). Additionally age less than 1 year at presentation (HR 1.31, p <0.001), lower Reflux grade (2.96, p <0.001 for grade I; 2.28, p <0.001 for grade II; 1.63, p <0.001 for grade III), Reflux diagnosed on postnatal evaluation for prenatal hydronephrosis or sibling screening (1.24, p = 0.002) a...

  • radiation exposure reduction during voiding cystourethrography in a pediatric porcine model of Vesicoureteral Reflux
    Radiology, 2006
    Co-Authors: Valerie L Ward, Craig A Peters, Carol E Barnewolt, Keith J Strauss, Robert L Lebowitz, Vaidehi Venkatakrishnan, Maximilian Stehr, Dawn L Mclellan, David Zurakowski
    Abstract:

    Purpose: To compare grid-controlled variable-rate pulsed fluoroscopy (GCPFL) and continuous fluoroscopy (CFL) for the reduction of radiation exposure during voiding cystourethrography (VCUG) in a pediatric porcine model of Vesicoureteral Reflux. Materials and Methods: Institutional animal care and use committee approval was obtained. Vesicoureteral Reflux was simulated in four pigs, and 48 VCUG studies were performed (24 with GCPFL, 24 with CFL). VCUG was performed at abdominal girths of 8–10 cm (group 1, simulates human newborn to 6-month-old infant), 12–13 cm (group 2, simulates 2–3-year-old child), and 15–17 cm (group 3, simulates 10-year-old child). An electronic device calculated total radiation exposure during fluoroscopy and image recording. With five-point ordinal scales, VCUG images were scored independently for anatomic conspicuity and overall diagnostic quality by two radiologists (radiologists A and B). An analysis of variance was used to compare radiation exposures and fluoroscopy times betwe...

Eric Colhoun - One of the best experts on this subject based on the ideXlab platform.

  • single center experience with endoscopic subureteral dextranomer hyaluronic acid injection as first line treatment in 1 551 children with intermediate and high grade Vesicoureteral Reflux
    The Journal of Urology, 2012
    Co-Authors: Prem Puri, Eric Colhoun, Balazs Kutasy, Manuela Hunziker
    Abstract:

    Purpose: In recent years the endoscopic injection of dextranomer/hyaluronic acid has become an established alternative to long-term antibiotic prophylaxis and the surgical management of Vesicoureteral Reflux. We determined the safety and effectiveness of the endoscopic injection of dextranomer/hyaluronic acid as first line treatment for high grade Vesicoureteral Reflux.Materials and Methods: Between 2001 and 2010, 1,551 children (496 male, 1,055 female, median age 1.6 years) underwent endoscopic correction of intermediate and high grade Vesicoureteral Reflux using dextranomer/hyaluronic acid soon after the diagnosis of Vesicoureteral Reflux on initial voiding cystourethrogram. Vesicoureteral Reflux was unilateral in 761 children and bilateral in 790. Renal scarring was detected in 369 (26.7%) of the 1,384 patients who underwent dimercapto-succinic acid imaging. Reflux grade in the 2,341 ureters was II in 98 (4.2%), III in 1,340 (57.3%), IV in 818 (34.9%) and V in 85 (3.6%). Followup ultrasound and voiding...

  • endoscopic treatment of moderate and high grade Vesicoureteral Reflux in infants using dextranomer hyaluronic acid
    The Journal of Urology, 2007
    Co-Authors: Prem Puri, Nochiparambil Mohanan, Maria Menezes, Eric Colhoun
    Abstract:

    Purpose: Renal parenchymal injury in Vesicoureteral Reflux occurs early, in most patients before age 3 years. It is generally believed that early prevention of urinary tract infections may decrease the amount of renal parenchymal damage. Endoscopic treatment for Vesicoureteral Reflux has become an established alternative to long-term antibiotic prophylaxis and ureteral reimplantation. We prospectively evaluated the effectiveness and safety of dextranomer/hyaluronic acid copolymer for high grade Vesicoureteral Reflux in infants.Materials and Methods: A total of 276 infants, including 124 boys and 152 girls, with a median age of 7 months (range 2 to 12) underwent endoscopic treatment for Vesicoureteral Reflux with dextranomer/hyaluronic acid. Reflux was detected in 225 infants following investigation for urinary tract infection, in 46 following screening for sibling Vesicoureteral Reflux and in 5 for prenatally diagnosed hydronephrosis. Vesicoureteral Reflux was unilateral in 85 infants and bilateral in 191...

  • subureteral dextranomer hyaluronic acid injection as first line treatment in the management of high grade Vesicoureteral Reflux
    The Journal of Urology, 2006
    Co-Authors: Prem Puri, Nochiparambil Mohanan, Martina A Pirker, Michal Dawrant, Laxman Dass, Eric Colhoun
    Abstract:

    Purpose: Endoscopic correction of Vesicoureteral Reflux has become an established alternative to long-term antibiotic prophylaxis and ureteral reimplantation. A number of tissue augmenting substances have been used for the endoscopic correction of Vesicoureteral Reflux. We prospectively evaluated the effectiveness of dextranomer/hyaluronic acid copolymer (Deflux®) as first line treatment for high grade Vesicoureteral Reflux.Materials and Methods: Between 2001 and 2004, 692 children with a median age of 2.1 years (3 months to 13.7 years) with high grade Vesicoureteral Reflux underwent endoscopic subureteral injection of Deflux® soon after the diagnosis of Vesicoureteral Reflux was made on the initial voiding cystourethrogram. Vesicoureteral Reflux was unilateral in 283 patients and bilateral in 409. Of the 1,101 ureters Vesicoureteral Reflux was grade II to V in 35 (3.2%), 580 (52.7%), 457 (41.5%) and 29 (2.6%), respectively. The procedure was performed on an outpatient basis. Followup ultrasound and voidi...

  • endoscopic treatment of Vesicoureteral Reflux 11 to 17 years of followup
    The Journal of Urology, 2002
    Co-Authors: Boris Chertin, Eric Colhoun, Murugesh Velayudham, Prem Puri
    Abstract:

    Purpose: We review our 17-experience with endoscopic subureteral polytetrafluoroethylene injection for the treatment of primary Vesicoureteral Reflux in children.Materials and Methods: We retrospectively reviewed the charts of 258 patients with primary Vesicoureteral Reflux who were treated with subureteral polytetrafluoroethylene injection from 1984 to 1990.Results: The study included 205 girls and 53 boys between 3 months and 14 years old (median age 6 years). Of the patients 92 had unilateral Vesicoureteral Reflux, 129 had bilateral Reflux and 37 had a Refluxing duplex system including 6 with bilateral duplex systems. Endoscopic treatment by subureteral polytetrafluoroethylene injection was performed in 393 ureters. Reflux was corrected in 302 ureters (76.8%) after a single injection. Injection failed to stop Reflux in 7 ureters (7 patients) and reimplantation was required. Patients were followed from 11 to 17 years with a mean followup plus or minus standard deviation of 13.5 ± 3.4 years. Four patient...