EFFICACY OF ENDOSCOPIC SUBURETERAL POLYDIMETHYLSILOXANE INJECTION FOR TREATMENT OF VESICOURETERAL REFLUX IN CHILDREN: A NORTH AMERICAN CLINICAL REPORT
Bibliographic record
Abstract
PURPOSE: Subureteral injection of bulking agents is an accepted surgical treatment of vesicoureteral reflux in children. Polydimethylsiloxane, a silicone elastomer, is an ideal agent because of bulky consistency, lack of migration, minimal local inflammatory reaction and is safe in laboratory animals. We record our experience with endoscopic subureteral polydimethylsiloxane injection in children for vesicoureteral reflux. MATERIALS AND METHODS: During a 2-year period 16 boys and 58 girls, with an average age of 8 years, with 112 refluxing ureters underwent endoscopic subureteral polydimethylsiloxane injection to treat vesicoureteral reflux. Vesicoureteral reflux was grade I in 8, II in 43, III in 50, IV in 10 and V in 1 ureter. Operative indications were breakthrough urinary tract infection in 29 children, nonresolution of reflux 38 and high grade reflux 7. All procedures were on an outpatient basis and performed with patient under general anesthesia. All children had a postoperative ultrasound and voiding cystourethrogram at 12 weeks. Followup was from 6 to 24 months. RESULTS: Overall, reflux was corrected in 90 (81%) ureters and 56 (76%) children after a single injection. With repeat injection reflux was corrected in 101 (90%) ureters and 63 (85%) children. Correction by grade was 85%, 84%, 80%, 45% and 0% for grades I to V, respectively. With repeat injection correction was 100%, 92%, 90% and 55% for grades I to IV, respectively. There were no surgical complications. De novo contralateral reflux developed in 2 (3%) children. There were 3 (4%) children who required open ureteral reimplantation for failed injection. Detection of the polydimethylsiloxane implant by followup ultrasound was 89% sensitive and 86% specific for the correction of reflux. CONCLUSIONS: Endoscopic subureteral polydimethylsiloxane injection is an effective treatment of vesicoureteral reflux in children. The procedure is safe with low associated morbidity. The presence of the polydimethylsiloxane implant can be documented accurately by ultrasound, and there is a strong correlation between implant stability and correction of reflux.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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 source (direct Gemma or distilled Codex), 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".