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Endoscopic Treatment of the Vesicoureteral Reflux by Electrocoagulation Yasin Idweini Saed* Department of Urology, Al Bashir Hospital, Amman Jordan

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Endoscopic Treatment of the Vesicoureteral Reflux by Electrocoagulation Yasin Idweini Saed* Department of Urology, Al Bashir Hospital, Amman Jordan www.symbiosisonline.org www.symbiosisonlinepublishing.com Research article Journal of Urology and Nephrology Open Access Endoscopic Treatment of the Vesicoureteral Reflux by Electrocoagulation Yasin Idweini Saed* Department of Urology, Al Bashir Hospital, Amman Jordan Received: June 23, 2017; Accepted: July 29, 2017; Published: August 23, 2017 *Corresponding author: Yasin Idweini Saed; Department of Urology, Al Bashir Hospital, Amman Jordan. E-mail: [email protected] Abstract Purpose: We reviewed our experience with endoscopic treatment of Comparison with other historical techniques and other authors. failure. Determination of further complementary techniques to do in case of Vesicoureteric Reflux (V.U.R) by electrocoagulation; as a simple technique to Materials and Methods Material and methods: Between January 1998 and December 2002, 150 determine the efficacy and lack of morbidity of this procedure. Between January 1998 and December 2002, 150 patients with Malepatients to female with vesicouretericratio was 2:8. Age reflux ranged (210 from refluxing 2 months ureter) to 47 years,underwent median: 291 7 years.endoscopic Localization electrocoagulation was bilateral in 39% the hemitrigoneRt. Side 20%, in Lt order Side 41%.to treat The the grade reflux. of patient(V.U.R) is(210 placed refluxing in the dorsalureter) lithotomy underwent position, consequence cystoscopy 291 is endoscopic performed andelectrocoagulation the ureters are in visualized,the hemitrigone a cautery in order probe to istreat advanced the reflux. through The of the cases. vesicoureteric reflux ranged from 2 to 5th grade. Secondary reflux was in 18% Results: Good results achieved in 85% of patients, 25% of the patients the working channel, electrocoagulation is done in a limited zone of the hemitrigone, distal to the ureteral orifice of the refluxing ureter, in diverticulum,underwent repeated ectopic coagulationureterocele, (2-3 posterior times). urethral12% underwent valves, ureteralsurgical rhomboid shape between the ureteric orifice and the bladder neck,(about treatment because of the associated abnormalities (paraureteral vesical 1cm square space).The electrocoagulation done by fine probe making thesuperficial end of theelectrocoagulation procedure to avoid dots bladder in the distention mucosa inof order the tomentioned enhance duplicationConclusions: etc.). limited zone in the trigone [Figure 13-16]. Foleys catheter is inserted at simple and safe procedure, with less morbidity, and it is cost effective. Endoscopic treatment of V.U.R. by electrocoagulation is a is less than 15 minutes. The patient is discharged from hospital the next Key Words: rapid healing of coagulated zone in the trigone; the length of procedure Treatment Vesicoureteric Reflux; Electrocoagulation; Endoscopic isday done after for removing follow up. Foleys Male catheter, to female keeping ratio was the 2:8.patient Age on ranged prophylactic from 2 Introduction antiseptic for 3 months, after that a Voiding Cystourethrogram (V.C.U.G) months to 42 years, (median 7 years.). Localization was: bilateral 39%, RT Vesicoureteric Reflux (V.U.R) indicates the retrograde flow of urine into side 20%, Lt Side 41%. Grading was GII: 35%, GIII: 33% GIV: 23%, GV: 9%. presentthe upper with urinary urinary tract. tract The infection overall incidence[1]. of reflux in normal children ranges from 1% to 18%. Reflux is found in up to 70% of infants who The vast majority (85%) of reflux occurs in female [2]. Males who present with urinary infection have a higher likelihood of having the anomaly. Primary reflux is congenital anomaly of the ureterovesical ratiojunction of tunnel in which length a deficiency to ureteral of the diameter longitudinal was foundmuscle in of normal the intravesical children ureters, results in an inadequate valvular mechanism. In one study a 5:1 without reflux [3]. Reflux occurs when the intravesical (intramural) Figure 13: ureteral length is too short. Secondary reflux is that caused by bladder Preoperative cystoscopic view of refluxing ureteric orifice obstruction and its consequent elevated pressures [4]. Familial reflux is common, being present in about one third of the siblings, in some studies, sibling reflux rate reached about 51%, [5]. Vesicoureteral reflux may damage the kidney by repeated introduction of infected urine into the kidneys or by hydrostatic pressure on the renal tissue causing reflux nephropathy, which could be detected by urinary cytokinesObjectives as a nephropathy marker [6]. Objectives of this study were introduction and evaluation of Figure 14: electrocoagulation treatment of V.U.R. electrocoagulation Postoperative cystoscopic view of refluxing ureteric orifice after SelectionSymbiosis Groupof proper*Corresponding patients, and determination author: [email protected] of its efficacy. Copyright: Endoscopic Treatment of the Vesicoureteral Reflux by Electrocoagulation © 2017 Yasin Idweini Classification and treatment Classification and treatment Group Treatment All of them were treated by electrocoagulation and low dose of prophylactic antiseptic during 3 months of the postoperative period. Those cases in which this treatment failed, the I. electrocoagulation was repeated twice Figure 15: Electrocoagulation Primary V.U.R case of failure of complete correction of or 3 times until the V.U.R resolved. In V.U.R, ureteral reimplantation is the rule II. in resolving such reflux SecondaryBladder V.U.R dysfunction or neurogenic bladder: treated with anticholenergic A drugs and prophylactic antiseptic and endoscopic electrocoagulation Associated with another anomalies: B treated regarding the cause Ablation of posterior urethral valves and electrocoagulation Optical urethrotomy and electrocoagulation Material: Pediatric cystoscope and electrode probe Figure 16: Marsupilization of ureterocele and heminephroureterectomy Classification of patients Marsupilization of ureterocele and Classification of patients ureteral reimplantation Group Patients duplication 124 Ureteral reimplantation in ureteral reimplantation in blind incomplete I. Primary V.U.R Ureterectomy and ureteral II. Secondary V.U.R 268 Taperingduplicated and ureteral refluxing reimplantation ureter in (II A) Neurogenic bladder 18 Paraureteralrefluxing divertilectomy megaureter and ureteral (II B) Associated to anotherPosterior anomalies urethral valves 2 reimplantation Stricture urethra 1 Ureteral reimplantation after recurrent 2 V.U.R. after pregnancy Ureterocele + duplication 4 Nephroureterectomy in non functioning kidney due to severe V.U.R Ureteral duplication 1 Results ParaureteralRefluxing megaureter diverticulum 3 In 85% of patients good results were achieved, 25% of the patients 1 vesicalneeded divertilectomy,repeated coagulation heminephroureterectomy, (2-3 times) (Table marsupilization 1) (Table 2). 12%of a Recurrent reflux after pregnancy 2 underwent surgical treatment ( ureteral reimplantation, paraureteral presence of associated abnormality as vesical diverticulum and saccules Non functioning kidney due to severe V.U.R ureterocele, ablation of posterior urethral valves… etc), because of the 2 with good results . Ectopic ureter with severe V.U.R near the ureteric orifices, ureterocele, posterior urethral valves … etc) Patients were followed up to five years including urine culture present,quarterly, bladder and radiologic dysfuncion studies should every be treated two years, with anticholenergics.low dos prophylactic antiseptic were continued until the reflux resolved as expected. When Citation: Page 2 of 6 Yasin Idweini S (2017) Endoscopic Treatment of the Vesicoureteral Reflux by Electrocoagulation.J Urol Nephrol Open Access 3(3): 1-6. DOI: 10.15226/2473-6430/3/3/00133 Copyright: Endoscopic Treatment of the Vesicoureteral Reflux by Electrocoagulation © 2017 Yasin Idweini Table 1 Relations of recurrent vesicoureteral reflux in ureters regarding to the complications in each group. age of patient. We divideResult the patient of treatment in 5 groups of V.U.R regarding by Electrocoagulation the associated pathology and evolution of Age ( years ) N of ureters Recurrent V.U.R. Complications Number N % Contralateral Good Result Group Cases of Recurrence ureters V.U.R. < 1 25 4 n % n % n % 16 30 17 1 147 83 * 1-5 94 13 13.8 (I) primary 124 177 V.U.R. 12 7 0 0.60 93 ** < 5 91 14 15.3 (II) 8 80 0 0 1652 20 * Duplication 10 Total 210 31 15 complete or 8 80 0 0 2 20 ** incomplete 6 Discussion (III) 2 22 0 0 7 77 * Neurogenic 8 9 bladder 0 0 0 0 9 100 ** For long time surgery was the only method of treatment of V.U.R. 1 100 0 0 0 0 * (IV) 1 1 in failure of medical treatment. Recently less invasive techniques were Megaureter 1 100 0 0 0 0 ** suggested to correct the V.U.R. endoscopically with acceptable results. This study was justified by the impact of the disease on the patients with 11 85 0 0 2 15 * its morbidity and to find a minimal invasive method for the treatment of (V) other 11 13 As the electrocoagulation is a simple, successful, durable and pathology V.U.R. 10 77 0 0 3 23 ** minimally invasive procedure, it was chosen for the treatment of the 52 25 0 0 157 75 * Total 150 210 conservativepatients avoiding therapy the isuse shortened. of long- term prophylactic urinary antiseptics 31 15 0 0 178 85 ** and periodic radiographic follow- up. Moreover, the time required for This treatment of electrocoagulation was performed early in Hungary * Revision at 3 months after treatment by electrocoagulation. by professor Gotz Frigyes et al, and had excellent results [15]. Our patients previously
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