title: Utility of an intra-operative cystogram with a simulated voiding phase after endoscopic treatment of vesicoureteral reflux.
abstract: OBJECTIVE
  To assess the utility of intraoperative cystogram with a simulated voiding phase after endoscopic treatment of vesicoureteral reflux (VUR).
  
  
  METHODS
  From September 2003 to June 2005, 24 children underwent injection of deflux for the treatment of VUR. A total of 38 ureters were treated. After deflux injection, our most recent 14 patients had a cystogram with simulated voiding phase to assess for the presence of VUR. All patients were scheduled for a voiding cystourethrogram (VCUG) three months postoperatively to assess for persistent reflux. The surgery was considered a success only if patients did not demonstrate reflux on their postoperative VCUG.
  
  
  RESULTS
  Of the 24 patients undergoing deflux injection, 14 had complete resolution of their VUR. Eight patients had persistent VUR and 2 patients were lost to follow-up. A total of 38 ureters were injected. Twenty-seven ureters no longer refluxed, while 8 ureters continued to reflux and 3 ureters were lost to follow-up. Fourteen patients had an intra-operative cystogram with simulated voiding phase. The intra-operative cystogram with simulated voiding phase was negative in all patients except for one patient who demonstrated the presence of de novo contralateral VUR. There were 7 true negatives on intra-operative cystogram with a simulated voiding phase and 6 false negatives.
  
  
  CONCLUSIONS
  Our results of endoscopic treatment of VUR compare well to the results reported by others in the literature. An intra-operative cystogram may demonstrate unsuspected contralateral reflux but does not appear to predict the success of deflux injections.
authors.affiliation: West Virginia University School of Medicine, Division of Urology, Morgantown, USA.
authors.forename: Adam E
authors.initials: AE
authors.lastname: Perlmutter
authors.forename: Can
authors.initials: C
authors.lastname: Talug
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Darbandi
authors.forename: Rocco
authors.initials: R
authors.lastname: Morabito
authors.forename: William F
authors.initials: WF
authors.lastname: Tarry
mesh_terms: D002648:Child; D002675:Child, Preschool; D003558:Cystoscopy; D003911:Dextrans / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage; D007223:Infant; D007432:Intraoperative Period; D008297:Male; D016896:Treatment Outcome; D014521:Urethra / Q000000981:diagnostic imaging*; D001743:Urinary Bladder / Q000000981:diagnostic imaging*; D014554:Urination / Q000502:physiology*; D014567:Urography / Q000379:methods*; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging* / Q000601:surgery*
chemical_list: D003911:Dextrans; C094535:deflux; D006820:Hyaluronic Acid