title: Intraoperative cystography pre- and post-endoscopic treatment for vesicoureteral reflux: guaranteed success?
abstract: OBJECTIVE
  This study was designed to investigate whether post-endoscopic treatment (ET) intraoperative cystography is predictive of treatment outcome.
  
  
  METHODS
  Patients diagnosed with vesicoureteral reflux (VUR) and treated endoscopically with polyacrylate/polyalcohol copolymer or dextranomer hyaluronic acid were studied prospectively between August 2009 and April 2011. Slow infusion pre-ET cystography was performed under anesthesia. Post-ET cystography was performed only if the intraoperative pre-ET results demonstrated VUR.
  
  
  RESULTS
  Over a period of 20 months, 23 patients were studied (18 girls, five boys), with an average age of 41.9 months (range 13 months-11 years). Thirty-two renal units with reflux were treated: nine bilateral cases, seven right, and seven left. The distribution of reflux grades was as follows: two grade I, 10 grade II, 11 grade III, nine grade IV. All injected ureters demonstrated grade 0 hydrodistention after the procedure. Twelve of 23 of the pre-ET cystography results were negative for VUR, indicating that the sensitivity of this test is 47% compared with the preoperative voiding cystourethrography (VCUG) or nuclear cystogram. There were no procedure complications.
  
  
  CONCLUSIONS
  Of all patients (n = 23), nearly 60% did not demonstrate pre-ET VUR on intraoperative cystography. If a postoperative VCUG had been performed on all patients, more than half would have received unnecessary radiation. Therefore, this study demonstrates that post-ET cystography does not predict the success of ET of VUR intraoperative. Pre-ET cystography under general anesthesia before ureteral injection, has very low sensitivity, creating false-negatives that may complicate the interpretation of post-ET cystography. We suggest that intraoperative cystography before and after ET fails to show clinical utility and should not be used to predict the outcome of endoscopic VUR treatment.
authors: Pediatric Urology Service, Dr. Exequiel González Cortés Hospital, Barros Luco 3301, San Miguel, Santiago, Chile; University of Chile, School of Medicine, Department of Pediatrics and Pediatric Surgery, Santiago, Chile; Clinica Alemana, Santiago, Chile. Electronic address: pejotalopez@yahoo.com.
authors: P-J
authors: PJ
authors: López
authors: Pediatric Urology Service, Dr. Exequiel González Cortés Hospital, Barros Luco 3301, San Miguel, Santiago, Chile.
authors: F
authors: F
authors: Reed
authors: Pediatric Urology Service, Dr. Exequiel González Cortés Hospital, Barros Luco 3301, San Miguel, Santiago, Chile; University of Chile, School of Medicine, Department of Pediatrics and Pediatric Surgery, Santiago, Chile.
authors: A
authors: A
authors: Ovalle
authors: Pediatric Urology Service, Dr. Exequiel González Cortés Hospital, Barros Luco 3301, San Miguel, Santiago, Chile.
authors: S
authors: S
authors: Celis
authors: Pediatric Urology Service, Dr. Exequiel González Cortés Hospital, Barros Luco 3301, San Miguel, Santiago, Chile.
authors: D
authors: D
authors: Reyes
authors: Pediatric Urology Service, Dr. Exequiel González Cortés Hospital, Barros Luco 3301, San Miguel, Santiago, Chile; University of Chile, School of Medicine, Department of Pediatrics and Pediatric Surgery, Santiago, Chile.
authors: N
authors: N
authors: Letelier
authors: Pediatric Urology Service, Dr. Exequiel González Cortés Hospital, Barros Luco 3301, San Miguel, Santiago, Chile; University of Chile, School of Medicine, Department of Pediatrics and Pediatric Surgery, Santiago, Chile; Clinica Alemana, Santiago, Chile.
authors: R
authors: R
authors: Zubieta
mesh_terms: D002648:Child; D002675:Child, Preschool; D003911:Dextrans; D004724:Endoscopy; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid; D007223:Infant; D007267:Injections; D007430:Intraoperative Care; D008297:Male; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014567:Urography; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging* / Q000601:surgery*
chemical_list: D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid
keywords: Endoscopic treatment; Intraoperative cystourethrography; Pediatrics; Success rate; Vesicoureteral reflux