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" Evaluation of Urocol as a Bulking Agent in Endoscopic treatment Of Vesicoureteral Reflux Isfahan 2005-2007 "
/یاسمن کیانیراد
; Mahtab Zargham, Hamid Mazdak
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Isfahan University of Medical Sciences
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| Document Type
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Latin Dissertation
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| Language of Document
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English
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| Record Number
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102664
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| Doc. No
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T10971
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WJ,500,K46e,2007
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| Main Entry
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Kianirad, Yasaman
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| Title & Author
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Evaluation of Urocol as a Bulking Agent in Endoscopic treatment Of Vesicoureteral Reflux Isfahan 2005-2007/یاسمن کیانیراد
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| College
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Schools, Medical
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| Date
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, 2007
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| Degree
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Medicine, MD
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| Page No
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54 p.:ill, tab
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| Note
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Orginal Works
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| Abstract
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Introduction: Vesicoureteral reflux (VUR) is the most common urinary abnormality in children and its incidence is estimated to be over 10 , generally. Until recently, the management options were limited to antibiotic prophylaxis and annual follow-up imaging or open surgery but in recent years the treatment of vesicoureteral reflux in children has seen a shift from invasive surgery to endoscopic management.A variety of different substances have been tried as bulking agent to eliminate vesicoureteral reflux but long term follow up has found drawbacks with each substance tried and ideal injection material is still under discussion. Urocol is a new promising tissue augmenting substance which might be able to replace other bulking agents in the endoscopic treatment. The long term efficacy of Urocol is not well difined and further studies are needed to elucidate its place in the algorithm for the management of this common problem in children.Objectives: We evaluated the effect of Urocol injection for the endoscopic treatment of vesicoureteral reflux and determined the effect of age, sex, grade and reflux site on success rate.Materials and Methods: In selfcontrol clinical trial study between February 2005 and June 2007, 24 patients (16 females and 8 males with mean age 11.3 ▒ 7.3 years) with 39 refluxing ureters underwent subureteral Urocol injection. The preoperative evaluation included history and physical examination, VCUG, renal and bladder ultrasonography,urinalysis .Wide spectrum antibiotic was given to all cases before operation. Follow up was consist of urinalysis every month, pelvicoabdominal sonography at 1st to 3rd month visit and VCUG 3 to 6 month after injection.Success of the treatment has been assessed by VCUG in 3rd to 6th month. Positive response was defined as absent of VUR on VCUG or reflux grade I in patints with grade II- V before operation_Result: After a single injection, refluxes were cured in 26 of 39 ureteral units (66.7 ). The success rate in the female and male was 69.2 and 61.5 , respectively. No statistically significant difference was found in the cure rate by sex (P>0.05). The success rate in the unilateral and bilateral reflux was 55.5 and 70 and there was no statistically significant difference in the cure rate by reflux site (P>0.05). The mean of age in patients with successful injection was 12 f 8 years and in patients with unsuccessful injection was 10 5 years. mean age had no statistically significant difference in two groups (P>0.05). The success rate in the mild grade reflux (I, II) was 78.5 and in the moderate and severe was 36.3 .there was statistically significant difference in the cure rate by grade of reflux (P=0.012). Logistic regression analysis demonstrated that mild preoperative VUR grade was statistically significant determination of success (p=0.005) and with regard to Odd's ratio probability of reflux resolution in mild grade was 3.67 times higher than moderate and severe grade (95 C.L=1.487 to 9.043).Discussion: Our study included 39 cases of primary VUR in which we applied Urocol. we have found an overall success rate of 66.7 .Procedure is simple and no additional equipment is required. Our result also included the only reported developing contralateral reflux after one subureteric injection of Urocol. In comparing our result to the prevailing literature due consideration should be given to the probable influence of patient selection and physician experience. It is less clear however,what factors predispose to success or failure. The presented data indicate that sex, refluxsite and age were not statistically significant factors influencing success in our study. Preoperative VUR grade appear to be important predictors of reflux resolution after endoscopic injection. Probability of reflux resolution in mild grade was 3.67 times more than moderate and severe grade. Conclusion: The results of this study demonstrate that in low grade VUR endoscopic subureteral Urocol injection seems to be an effective, safe and minimally invasive..
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| Descriptor
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1.Vesico- Ureteral Reflux- therapy.- Descriptors: Vesico- Ureteral Reflux
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Endoscopy
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Urination Disorders
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Child
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Antibiotics
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| Added Entry
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Zargham, Mahtab, Supervisor
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Mazdak, Hamid, Supervisor
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