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| Modified unilateral periureteral injection technique in the treatment of patients with high-grade vesicoureteral reflux: A study of primary findings |
Seyed Alaeddin Asgaria,Afshin Safaei-Aslb,Mandana Mansour-Ghanaiea,Seyed Mohammad Asgaria,Asghar Faryabia,Mohammadreza Bazlia,Faezeh Emami Sigaroudib,Seyed Ahmad Naseri Alavic,*( )
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a Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
b School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
c Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran |
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Abstract Objective:Although endoscopic treatment has been used by many pediatric urologists for the treatment of vesicoureteral reflux (VUR), it has no considerable success in high-grade VUR. We aimed to describe the primary outcomes of unilateral periureteral injection technique (PIT), as well as bilateral PIT in high-grade VUR. Methods:In this prospective study, we examined 92 ureters in 45 boys and 40 girls from February 2010 to May 2018. Bilateral PIT and unilateral PIT were applied in 67 and 25 refluxing units, respectively. In the unilateral PIT, the subureteral injection site was only at the 5- or 7-o'clock position. However, in the bilateral PIT, the subureteral injection sites were at 5- and 7-o'clock position. Pre- and post-operative reflux grades were evaluated by voiding cystourethrography 6 months after surgery. Results:Seven patients had bilateral reflux. Overall, 75 (81.5%) ureters showed Grade IV VUR, while 17 (18.5%) had primary Grade V VUR. The mean age of the subjects was 39.2 months. In unilateral PIT ureters, VUR was resolved in 23 (92.0%) refluxing units. It was downgraded to Grade III in one ureter (4.0%) and to Grade II in another ureter (4.0%). In addition, in bilateral PIT cases, VUR was resolved in 60 (89.6%) ureters; it downgraded to Grades II and III in 3 (4.5%) and 4 (6.0%) refluxing units, respectively. Conclusion:Unilateral PIT can be highly effective in the treatment of selected ureters of high-grade VUR. However, further studies are needed to confirm our results.
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Received: 13 January 2021
Available online: 20 January 2023
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Corresponding Authors:
Seyed Ahmad Naseri Alavi
E-mail: dr.arsalan2010@gmail.com
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| Variable | Value | | Mean age, mean±SD (range), month | 39.2±8.4 (8.0-126.0) | | Refluxing unit, n (%) | | Grade IV | 75 (81.5) | | Grade V | 17 (18.5) | VUR completely resolved, n (%)
Bilateral PIT (n=67)
Unilateral PIT (n=25) |
60 (89.6)
23 (92.0) | | Downgraded to Grade II, n (%) | Bilateral PIT (n=67)
Unilateral PIT (n=25) | 3 (4.5)
1 (4.0) | Downgraded to Grade III, n (%)
Bilateral PIT (n=67)
Unilateral PIT (n=25) |
4 (6.0)
1 (4.0) | | Sex, n (%) | | Boy | 45 (52.9) | | Girl | 40 (47.1) | | Laterality, n (%) | | Left | 33 (38.8) | | Right | 45 (52.9) | | Bilateral | 7 (8.2) | | Post-surgery complications, n (%) | | Fever | 2 (2.4) | | Dysuria | 6 (7.1) | | Flank pain | 2 (2.4) |
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The demographic and clinical characteristics of patients and study results.
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