Korean J Urol.  2015 Jul;56(7):533-539. 10.4111/kju.2015.56.7.533.

Postoperative ureteral obstruction after endoscopic treatment for vesicoureteral reflux

• Chung JM
• Park CS
• Lee SD

• KMID: 2160651
• DOI: http://doi.org/10.4111/kju.2015.56.7.533

Abstract

PURPOSE
We undertook this study to evaluate the incidence, risk factors, management, and outcome of postoperative ureteral obstruction after endoscopic treatment for vesicoureteral reflux (VUR).
MATERIALS AND METHODS
Ninety patients undergoing endoscopic treatment for VUR were retrospectively reviewed and classified into two groups according to ureteral obstruction: the nonobstruction group (83 cases, 122 ureters; mean age, 7.0+/-2.8 years) and the obstruction group (7 cases, 10 ureters; mean age, 6.2+/-8.1 years). We analyzed the following factors: age, sex, injection material, laterality, voiding dysfunction, constipation, renal scarring, preoperative and postoperative ultrasound findings, endoscopic findings, injection number, and injection volume. Additionally, we reviewed the clinical manifestations, natural course, management, and outcome of ureteral obstruction after endoscopic treatment.
RESULTS
The incidence of ureteral obstruction after endoscopic treatment was 7.6% (10/132 ureters). The type of bulking agent used and injection volume tended to be associated with ureteral obstruction. However, no significant risk factors for obstruction were identified between the two groups. Three patients showed no symptoms or signs after the onset of ureteral obstruction. Most of the patients with ureteral obstruction experienced spontaneous resolution within 1 month with conservative therapy. Two patients required temporary ureteral stents to release the ureteral obstruction.
CONCLUSIONS
In our experience, the incidence of ureteral obstruction was slightly higher than in previous reports. Our study identified no predictive risk factors for developing ureteral obstruction after endoscopic treatment. Although most of the ureteral obstructions resolved spontaneously within 1 month, some cases required drainage to relieve symptoms or to prevent renal function deterioration.

Keyword

Child; Cystoscopy; Ureteral obstruction; Vesico-ureteral reflux

MeSH Terms

Adolescent
Child
Child, Preschool
Cystoscopy/*adverse effects
Drainage
Female
Humans
Hydronephrosis/etiology
Male
Postoperative Period
Prognosis
Remission, Spontaneous
Retrospective Studies
Risk Factors
Stents
Ureteral Obstruction/*etiology/pathology/therapy
Vesico-Ureteral Reflux/*surgery

Reference

1. Gargollo PC, Diamond DA. Therapy insight: what nephrologists need to know about primary vesicoureteral reflux. Nat Clin Pract Nephrol. 2007; 3:551–563.

2. Matouschek E. Treatment of vesicorenal reflux by transurethral teflon-injection (author's transl). Urologe A. 1981; 20:263–264.

3. Wacksman J. Initial results with the Cohen cross-trigonal ureteroneocystotomy. J Urol. 1983; 129:1198–1199.

4. Burbige KA. Ureteral reimplantation: a comparison of results with the cross-trigonal and Politano-Leadbetter techniques in 120 patients. J Urol. 1991; 146:1352–1353.

5. Holmdahl G, Brandstrom P, Lackgren G, Sillen U, Stokland E, Jodal U, et al. The Swedish reflux trial in children: II. Vesicoureteral reflux outcome. J Urol. 2010; 184:280–285.

6. Puri P, Mohanan N, Menezes M, Colhoun E. Endoscopic treatment of moderate and high grade vesicoureteral reflux in infants using dextranomer/hyaluronic acid. J Urol. 2007; 178(4 Pt 2):1714–1716.

7. Dave S, Lorenzo AJ, Khoury AE, Braga LH, Skeldon SJ, Suoub M, et al. Learning from the learning curve: factors associated with successful endoscopic correction of vesicoureteral reflux using dextranomer/hyaluronic acid copolymer. J Urol. 2008; 180:4 Suppl. 1594–1599.

8. Kaye JD, Srinivasan AK, Delaney C, Cerwinka WH, Elmore JM, Scherz HC, et al. Clinical and radiographic results of endoscopic injection for vesicoureteral reflux: defining measures of success. J Pediatr Urol. 2012; 8:297–303.

9. Hacker FM, Frech-Dorfler M, von Rotz M, Rudin C. Endoscopic hyaluronic acid/dextranomer gel implantation is effective as first-line treatment of vesicoureteral reflux (VUR) in children: a single centre experience. Eur J Pediatr Surg. 2011; 21:299–303.

10. Kempf C, Winkelmann B, Roigas J, Querfeld U, Muller D. Severe complications after endoscopic injection of polydimethylsiloxane for the treatment of vesicoureteral reflux in early childhood. Scand J Urol Nephrol. 2010; 44:347–353.

11. Vandersteen DR, Routh JC, Kirsch AJ, Scherz HC, Ritchey ML, Shapiro E, et al. Postoperative ureteral obstruction after subureteral injection of dextranomer/hyaluronic Acid copolymer. J Urol. 2006; 176(4 Pt 1):1593–1595.

12. Snodgrass WT. Obstruction of a dysmorphic ureter following dextranomer/hyaluronic acid copolymer. J Urol. 2004; 171:395–396.

13. Garcia-Aparicio L, Rodo J, Palazon P, Martin O, Blazquez-Gomez E, Manzanares A, et al. Acute and delayed vesicoureteral obstruction after endoscopic treatment of primary vesicoureteral reflux with dextranomer/hyaluronic acid copolymer: why and how to manage. J Pediatr Urol. 2013; 9:493–497.

14. Mazzone L, Gobet R, Gonzalez R, Zweifel N, Weber DM. Ureteral obstruction following injection of dextranomer/hyaluronic acid copolymer: an infrequent but relevant complication. J Pediatr Urol. 2012; 8:514–519.

15. Chertin B, Prosolovich K, Aharon S, Nativ O, Halachmi S. Surgical reimplantation for the correction of vesicoureteral reflux following failed endoscopic injection. Adv Urol. 2011; 2011:352716.

16. Cerwinka WH, Scherz HC, Kirsch AJ. Endoscopic treatment of vesicoureteral reflux associated with paraureteral diverticula in children. J Urol. 2007; 178(4 Pt 1):1469–1473.

17. Lackgren G, Wahlin N, Skoldenberg E, Stenberg A. Long-term followup of children treated with dextranomer/hyaluronic acid copolymer for vesicoureteral reflux. J Urol. 2001; 166:1887–1892.

18. Joyner BD, Atala A. Endoscopic substances for the treatment of vesicoureteral reflux. Urology. 1997; 50:489–494.

19. Al-Hunayan AA, Kehinde EO, Elsalam MA, Al-Mukhtar RS. Outcome of endoscopic treatment for vesicoureteral reflux in children using polydimethylsiloxane. J Urol. 2002; 168:2181–2183.

20. Serrano Durba A, Bonillo Garcia MA, Moragues Estornell F, Dominguez Hinarejos C, Sanguesa C, Martinez Verduch M, et al. Vesicoureteric reflux endoscopic treatment complications in childhood. Actas Urol Esp. 2006; 30:170–174.

21. Seifert HH, Mazzola B, Zellweger T, Ruszat R, Muller A, Burkhalter F, et al. Ureteral obstruction after dextranomer/hyaluronic acid copolymer injection for treatment of secondary vesicoureteral reflux after renal transplantation. Urology. 2006; 68:203.e17–203.e19.

22. Nelson CP, Chow JS. Dextranomer/hyaluronic acid copolymer (Deflux) implants mimicking distal ureteral calculi on CT. Pediatr Radiol. 2008; 38:104–106.

23. Noe HN. Calcification in a Deflux bleb thought to be a ureteral calculus in a child. J Pediatr Urol. 2008; 4:88–89.

24. McMann LP, Scherz HC, Kirsch AJ. Long-term preservation of dextranomer/hyaluronic acid copolymer implants after endoscopic treatment of vesicoureteral reflux in children: a sonographic volumetric analysis. J Urol. 2007; 177:316–320.

25. Sorensen MD, Koyle MA, Cowan CA, Zamilpa I, Shnorhavorian M, Lendvay TS. Injection volumes of dextranomer/hyaluronic acid are increasing in the endoscopic management of vesicoureteral reflux. Pediatr Surg Int. 2010; 26:509–513.

26. Puri P, Pirker M, Mohanan N, Dawrant M, Dass L, Colhoun E. Subureteral dextranomer/hyaluronic acid injection as first line treatment in the management of high grade vesicoureteral reflux. J Urol. 2006; 176(4 Pt 2):1856–1859.

27. Kirsch AJ, Perez-Brayfield MR, Scherz HC. Minimally invasive treatment of vesicoureteral reflux with endoscopic injection of dextranomer/hyaluronic acid copolymer: the Children's Hospitals of Atlanta experience. J Urol. 2003; 170:211–215.

28. Charbonneau SG, Tackett LD, Gray EH, Caesar RE, Caldamone AA. Is long-term sonographic followup necessary after uncomplicated ureteral reimplantation in children? J Urol. 2005; 174(4 Pt 1):1429–1431.

29. Grossklaus DJ, Pope JC, Adams MC, Brock JW. Is postoperative cystography necessary after ureteral reimplantation? Urology. 2001; 58:1041–1045.