Ultrasonographic mound height as predictor of vesicoureteral reflux resolution after endoscopic treatment in children

Abstract

Purpose: Endoscopic dextranomer/hyaluronic acid copolymer (Dx/HA) injection is a safe and efficacious treatment option for vesicoureteral reflux (VUR) in children. Endoscopic appearance, hydrodistention and amount of injected Dx/HA have been demonstrated not to be reliable predictors of outcome. Aim of this study was to evaluate Dx/HA mounds on ultrasound scans (US) and find out any eventual correlation with reflux resolution. Methods: We selected patients treated with endoscopic injection for moderate to high VUR, renal scaring or repeated infections under antibiotic prophylaxis. Success was defined by absence of VUR at control 3. months after surgery; at 3. months we also measured mound height ultrasonographically. Results: We considered a total of 32 children (15 male, 17 female; 53 ureters) with a median age of 3. years (±. 24. months). Overall success rate was 77% per ureter. Success rate correlates directly with age and inversely with VUR grade. Mound height is the major predictive parameter for reflux resolution (sensitivity 100%, specificity 65.9%); mean mound heights of success-group vs. persistence-of-reflux group were 9.97. ±. 1.61. mm and 7.29. ±. 1.74. mm respectively (p. <. 0.0005). Conclusion: A mound measuring at least 9.8. mm at post-operative US scan is a predictor of reflux resolution. Age and grade also seems to influence success rate.