title: Endoscopic treatment of vesicoureteral reflux using dextranomer/hyaluronic acid copolymer in children: results of postoperative follow-up with real-time 3D sonography.
abstract: OBJECTIVE
  We evaluated whether real-time 3D ultrasound (4D-US) together with clinical evaluation is an alternative to voiding cystourethrography (VCUG) after endoscopic treatment of vesicoureteral reflux (VUR) in children at postoperative follow-up.
  
  
  METHODS
  We reviewed 178 children who underwent endoscopic therapy with dextranomer/hyaluronic acid copolymer in grade II or III VUR between 2002 and 2005. 4D-US was performed in all patients 1 day and 3, 9 and 18 months after endoscopic therapy. Only children with postoperative urinary tract infections (UTIs) and/or nonorthotopic position of the bulking agent were referred for VCUG.
  
  
  RESULTS
  In 93% of the ureteral units, the depot could be detected in the orthotopic position after 3, 9 and 18 months. None of these children developed UTIs in the postoperative follow-up. Twelve children demonstrated a shifting of the depot, indicating a possible therapy failure. Eight of these 12 patients (66.7%) presented a positive VCUG, and 50% of them sustained UTIs.
  
  
  CONCLUSIONS
  4D-US seems to be a sufficient protocol in the follow-up of children after endoscopic treatment of low-grade VUR. VCUG should be performed in cases of a shifted position of the depot; invasive investigations are unnecessary in asymptomatic children with orthotopic bulk.
authors.affiliation: Department of Urology and Pediatric Urology, Medical University Innsbruck, Innsbruck, Austria. Renate.Pichler@i-med.ac.at
authors.forename: Renate
authors.initials: R
authors.lastname: Pichler
authors.forename: Alexander
authors.initials: A
authors.lastname: Buttazzoni
authors.forename: Jasmin
authors.initials: J
authors.lastname: Bektic
authors.forename: Barbara
authors.initials: B
authors.lastname: Schlenck
authors.forename: Christian
authors.initials: C
authors.lastname: Radmayr
authors.forename: Peter
authors.initials: P
authors.lastname: Rehder
authors.forename: Josef
authors.initials: J
authors.lastname: Oswald
mesh_terms: D002648:Child; D002675:Child, Preschool; D003911:Dextrans / Q000737:chemistry*; D004724:Endoscopy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000737:chemistry*; D021621:Imaging, Three-Dimensional / Q000379:methods; D007223:Infant; D010372:Pediatrics / Q000379:methods; D011108:Polymers / Q000737:chemistry*; D011184:Postoperative Period; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods; D014567:Urography / Q000379:methods; D014718:Vesico-Ureteral Reflux / Q000503:physiopathology* / Q000628:therapy*
chemical_list: D003911:Dextrans; D011108:Polymers; C013471:dextranomer; D006820:Hyaluronic Acid