title: Endoscopic antireflux surgery leading to obstruction in pediatric renal transplant patients.
abstract: To describe a multicenter experience with management of ureteral obstruction after injection of Dx/HA for VUR in pediatric renal transplant patients. The records of all pediatric renal transplant patients who underwent Dx/HA injection for VUR and had subsequent obstruction were identified, and the management and outcomes were reviewed. Follow-up ranged from 1 to 10 years. There were four patients identified, all of whom had a history of rising creatinine, recurrent UTI, and increasing hydronephrosis which led to the diagnosis of high-grade VUR. Obstruction was diagnosed within 24-72 hours after injection in three patients. One patient was asymptomatic, and rising creatinine and hydronephrosis were noted 1 month after injection. One patient was managed expectantly, while three patients underwent ureteral stent placement. After the stent was removed, one patient went on to open reimplant due to delayed obstruction, the second patient with voiding dysfunction is currently managed with an indwelling ureteral stent and may require further definitive surgery, the third patient recovered, and the fourth is being observed. Our cases illustrate that despite initial successful management of the obstruction in some, delayed obstruction is possible and may necessitate open reimplant. It is imperative that these patients have close follow-up after Dx/HA.
authors: Urology, University of California San Diego, San Diego, CA, USA.
authors: Gina
authors: G
authors: Cambareri
authors: Urology, Rutgers-New Jersey Medical School, Newark, NJ, USA.
authors: Christina
authors: C
authors: Carpenter
authors: Urology, Rutgers-New Jersey Medical School, Newark, NJ, USA.
authors: Jeffrey
authors: J
authors: Stock
authors: Urology, University of Minnesota, Minneapolis, MN, USA.
authors: Jane
authors: J
authors: Lewis
authors: Urology, University of California San Diego, San Diego, CA, USA.
authors: Sarah
authors: S
authors: Marietti
mesh_terms: D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000032:analysis; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage; D006869:Hydronephrosis / Q000150:complications; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D051437:Renal Insufficiency / Q000150:complications* / Q000601:surgery*; D012189:Retrospective Studies; D012306:Risk; D016896:Treatment Outcome; D014513:Ureter / Q000473:pathology; D014517:Ureteral Obstruction / Q000209:etiology*; D014552:Urinary Tract Infections / Q000150:complications; D014718:Vesico-Ureteral Reflux / Q000601:surgery*
chemical_list: D006820:Hyaluronic Acid; D003404:Creatinine
keywords: dextranomer/hyaluronic acid; obstruction; pediatrics; renal transplant; vesicoureteral reflux