Efficacy of Three Different Injection Techniques for the Endoscopic Treatment of Vesicoureteral Reflux (VUR) in Children: A Review of 10 Years of Experience

Giulia Lanfranchi; Irene Paraboschi; Ugo Maria Pierucci; Guglielmo Mantica; Sara Costanzo; Federica Marinoni; Andrea Pansini; Giorgio Giuseppe Orlando Selvaggio; Gloria Pelizzo

doi:10.2147/RRU.S467018

Efficacy of Three Different Injection Techniques for the Endoscopic Treatment of Vesicoureteral Reflux (VUR) in Children: A Review of 10 Years of Experience

Res Rep Urol. 2024 Jul 3:16:151-159. doi: 10.2147/RRU.S467018. eCollection 2024.

Authors

Giulia Lanfranchi¹, Irene Paraboschi², Ugo Maria Pierucci¹, Guglielmo Mantica³, Sara Costanzo¹, Federica Marinoni¹, Andrea Pansini¹, Giorgio Giuseppe Orlando Selvaggio¹, Gloria Pelizzo^{1

2}

Affiliations

¹ Department of Pediatric Surgery, Buzzi Children's Hospital, Milan, 20154, Italy.
² Department of Biomedical and Clinical Sciences "L Sacco", University of Milano, Milan, 20157, Italy.
³ Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, 16131, Italy.

Abstract

Aim: To review our 10 years of experience with the endoscopic treatment of vesicoureteral reflux (VUR) in children, emphasizing the long-term efficacy of the "combined STING-HIT" technique.

Materials and methods: A retrospective study was performed including all children with symptomatic VUR undergoing the cystoscopic injection of bulking agents from January 2013 to December 2022 in our pediatric tertiary referral center. Three different endoscopic techniques were adopted: the "combined STING-HIT" technique, the STING technique, and the HIT technique. Treatment success was defined as symptom remission and VUR resolution on the voiding cystourethrogram (VCUG) performed at the 3-month follow-up.

Results: In the study period, 140 (F:M = 64:76) patients and 228 ureters were treated at a median patient age of 3 (2.0-6.0) years. After a single endoscopic treatment, VUR resolved in 203 (88%) ureters. The VUR resolution rate after a single endoscopic treatment was 95% (n=70/74) in case of I-II VUR, 88% (n=87/99) in case of III VUR; 83% (n=38/46) in case of IV VUR; 89% (n=8/9) in case of V VUR (p-value: 0.174). Overall, one or two endoscopic treatments succeeded in 219 (96%) ureters. The overall VUR resolution rate following one or two endoscopic treatments was 100% (74/74) in case of I-II VUR, 93% (n=92/99) in case of III VUR; 96% (n=44/46) in case of IV VUR; 100% (n=9/9) in case of V VUR (p-value: 0.083). Despite not being statistically significant, the VUR resolution rate was higher for the "combined STING-HIT" technique, both after one (92%: n=110/119; versus 85%; n=62/73 versus 86%; n=31/36; p-value: 0.225) or two (98%: n=116/119; versus 95%; n=69/73 versus 94%; n=34/36; p-value: 0.469) endoscopic treatments.

Conclusion: The endoscopic approaches were highly successful for the treatment of VUR in children. The "combined STING-HIT" technique was a safe and effective procedure, being associated with the higher resolution rate.

Keywords: endoscopic technique; injection technique; pediatrics; vesicoureteral reflux.