title: Clinical and radiographic results of endoscopic injection for vesicoureteral reflux: defining measures of success.
abstract: OBJECTIVE
  Criteria for success following endoscopic vesicoureteral reflux (VUR) surgery vary greatly. We sought to define outcomes based on radiographic and long-term clinical follow up.
  
  
  METHODS
  We reviewed the charts and interviewed parents of children who underwent endoscopic treatment for primary VUR (grades I-IV). All patients had a postoperative voiding cystourethrogram (VCUG) at mean of 3 months (1-21 months) and all cases of postoperative febrile urinary tract infection (FUTI) prompted repeat VCUG. Radiographic success was defined as no VUR on postoperative VCUG and clinical success as no FUTIs during follow up of 12-36 months. To demonstrate how criteria for success can affect outcomes, we calculated the success rates using different definitions.
  
  
  RESULTS
  In 2004-2008, 336 patients (296 female and 40 male, mean age 4 years) were treated with dextranomer/hyaluronic acid via the Double-HIT method. Initial radiographic success was 90% (302/336). Of these, 19 (6%) developed FUTIs, 12 (4%) of whom had recurrent VUR, and 5 (2%) went on to open surgery. Of the radiographic failures, 18% were observed with no further treatment. Success defined clinically was 94% (281/300), and as 'radiographic cure and no clinical evidence of FUTIs' it was 82% (275/336).
  
  
  CONCLUSIONS
  It is important to agree on a universal definition of success for VUR interventions to compare across studies and across therapies. Clinical success is more meaningful to the patient, and initial radiographic success could be followed by UTI necessitating further intervention. We question the need for routine postoperative VCUG.
authors.affiliation: Department of Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA 30342, USA.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Kaye
authors.forename: Arun K
authors.initials: AK
authors.lastname: Srinivasan
authors.forename: Christina
authors.initials: C
authors.lastname: Delaney
authors.forename: Wolfgang H
authors.initials: WH
authors.lastname: Cerwinka
authors.forename: James M
authors.initials: JM
authors.lastname: Elmore
authors.forename: Hal C
authors.initials: HC
authors.lastname: Scherz
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kirsch
mesh_terms: D002675:Child, Preschool; D003911:Dextrans / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007267:Injections; D008297:Male; D019736:Prostheses and Implants; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014513:Ureter; D018666:Ureteroscopy / Q000379:methods*; D014563:Urodynamics; D014567:Urography / Q000379:methods*; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D055675:Viscosupplements / Q000008:administration & dosage
chemical_list: D003911:Dextrans; D055675:Viscosupplements; C013471:dextranomer; D006820:Hyaluronic Acid