Endoscopic treatment of vesicoureteric reflux with Deflux: a Canadian experience
Bibliographic record
Abstract
INTRODUCTION: Vesicoureteric reflux is a common problem encountered in urological practice. Traditionally, if medical management with low-dose antibiotic prophylaxis failed, the only alternative was ureteroneocystostomy. Recently, promising results with subureteric injection of dextranomer/hyaluronic acid copolymer (Deflux) have renewed interest in the endoscopic treatment of vesicoureteric reflux (VUR). OBJECTIVE: We reviewed the outcome of the subtrigonal injection (STING) procedure with Deflux at a single pediatric hospital and included the rate of VUR resolution and complications. METHODS: An Institutional Review Board approved the retrospective review of all cases of STING performed with Deflux at the Children's Hospital of Eastern Ontario, from April 2003 to October 2005. We used voiding cystourethrogram (VCUG) or radionuclide cystogram (RNC) for diagnosis of VUR. The most common indications for surgery were breakthrough infection, progression of renal scars and parental preference. A subureteral or intra-ureteral injection, at the 6 o'clock position, delivered the material to support the ureter and correct VUR. RESULTS: We reviewed the cases of 64 patients, 47 girls (73%) and 17 boys (27%), with a mean age of 6 years (range 1-17 yr) and a mean follow-up of 8 months (range 2-23 mo). A total of 26 patients (41%) had bilateral VUR and 38 (59%) had unilateral VUR (90 renal units were treated). Overall cure rate was 79.7% (51/64) per child and 74% (67/90) per renal unit. Among the 64 patients treated, 62.5% (40/64) were cured with a single injection, and a second and third injection raised the cure rate to 78% (50/64) and 79.7% (51/64), respectively. Contralateral low-grade de novo VUR was present in 7.9% (3/38) of the 38 unilateral cases. Postoperatively, de novo hydronephrosis developed in 3.3% (3/90) of the ureters, in 2 patients. CONCLUSIONS: The endoscopic treatment of VUR with Deflux is a feasible outpatient procedure, requires minimal operating room time and is associated with low morbidity. In our study, it demonstrated a cure rate of 80% of patients and 74% of renal units. Dysfunctional voiding and neurogenic bladder (NB) do not seem to adversely affect results. STING should be considered for failed open reimplants, because it is much less morbid than redo reimplants. Further experience with the material and increased use of intraureteral injection may improve our cure rates.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".