[Predictive value of ureteral dilation rate in the success of endoscopic correction of vesicoureteral reflux in pediatric patients].
OBJECTIVE
30-50% of pediatric patients with the diagnosis of lower urinary tract infection (UTI) have vesicoureteral reflux (VUR). The endoscopic treatment of VUR has become one of the main therapeutic tools and its success has been traditionally related to the grade of VUR. Nevertheless, in each of the VUR grades different grades of ureteral dilation may be observed. The aim of the study is to evaluate the influence of ureteral dilation rate in the cure rate after endoscopic treatment.


METHODS
From a total of 632 renal units with reflux treated endoscopically, we review the first four years (1996-1999). After discarding patients with secondary VUR (neurogenic bladder, ureteral duplication) 70 patients enter the study (a total of 105 renal units with reflux). Voiding cystourethrograms (VCUG) were evaluated by means of a double blind study, grading ureteral dilation of all patients in three grades: mild-normal, moderate and severe. We performed comparisons between the cure rates of first endoscopic injection in the three grades of ureteral dilation.


RESULTS
After the evaluation of VCUG in the double blind study, from 105 renal units with reflux in the study, three had grade I VUR, 12 grade II, 64 grade III, and 26 grade IV. After grading ureteral dilation there were 45 with mild-normal grade, 44 moderate and 16 severe. The comparison of cure rates for grade III and IV VUR without considering the grade of ureteral dilation did not show statistical significance. Nevertheless, we found statistically significant differences between the cure rates of each grade of ureteral dilation: when considering all renal units with reflux treated, considering all grade III and IV VUR, and considering only grade III reflux.


CONCLUSIONS
The international classification of VUR as a prognostic factor for the success of endoscopic treatment does not considered differences between some degree refluxes. The results observed demonstrate that grade of ureteral dilation must be evaluated in conjunction with grade of reflux at the time of making prognosis about the success of endoscopic treatment of VUR.
Argibay
Iván Somoza
IS
Servicio de Cirugía Pediátrica, Hospital Materno Infantil Teresa Herrera, Complejo Hospitalario Juan Canalejo, La Coruña, España. isomoza@canalejo.org
Molina Vázquez
Elena
E
Vela Nieto
Diego
D
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003558:Cystoscopy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D012074:Remission Induction; D018666:Ureteroscopy; D014718:Vesico-Ureteral Reflux / Q000150:complications* / Q000473:pathology / Q000601:surgery*