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Successful rescue pneumovesicoscopic surgery for post-Deflux® vesicoureteral junction obstruction

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Abstract

Background

Vesicoureteral junction (VUJ) obstruction after Deflux® subureteral injection for vesicoureteral reflux (VUR) is rare and minimally invasive management has not been reported. This work investigated the patients who underwent Deflux® injection for VUR and identified those with subsequent VUJ obstruction.

Methods

Medical records of matched patients from October 2003 to March 2022 were reviewed, and parameters were retrospectively studied. All patients underwent Deflux® injection. The injection was performed under general anesthesia using the same manner. For patients complicated with VUJ obstruction, the symptoms, signs, management, images, renal ultrasounds, Tc-99m dimercaptosuccinic acid renal scintigraphy, histology of VUJ region, and outcomes were documented and reported. VUJ stenosis was diagnosed by performing renal ultrasound and magnetic resonance imaging.

Results

Totally 407 patients (554 ureterorenal units) received Dx/HA injections for VUR. VUJ obstruction was found in three patients (four ureterorenal units). Originally, three were grade V VUR, and one was grade IV. The repeated injection was not a risk factor for VUJ obstruction. The overall incidence of VUJ obstruction post-Dx/HA injection was 0.7% by ureter. The incidences were 0%, 0.75%, and 2.25% for grade I–III, IV, and V VUR, respectively. After the initial conversion case of pneumovesicoscopic ureteral reimplantation, the procedure was performed smoothly and successfully in the two following cases.

Conclusions

Pneumovesicoscopic ureteral reimplantation offers an alternative for VUJ obstruction following Dx/HA injection for VUR. Fibrosis and foreign-body reaction may influence the feasibility. High-grade VUR and young age of injection were related to VUJ obstruction.

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Data availability

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Acknowledgements

This research was funded by Taichung Veterans General Hospital, grant number TCVGH-1125401B.

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Authors and Affiliations

  1. Division of Urology, Department of Surgery, Taichung Veterans General Hospital, 1650, Sec. 4, Taiwan Boulevard, Taichung, 407219, Taiwan

    Li-Yu Yang

  2. Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, 407219, Taiwan

    Chia-Man Chou, Sheng-Yang Huang & Hou-Chuan Chen

  3. School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, 112304, Taiwan

    Chia-Man Chou & Sheng-Yang Huang

  4. Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, 402202, Taiwan

    Chia-Man Chou & Sheng-Yang Huang

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Contributions

Conceptualization, CMC and SYH; methodology, CMC and SYH; software, LYY and SYH; validation, CMC and HCC; formal analysis, LYY and SYH; investigation, LYY and SYH; resources, CMC and HCC; data curation, LYY and SYH; writing—original draft preparation, LYY; writing—review and editing, SYH; visualization, LYY and SYH; supervision, CMC and HCC; project administration, SYH; funding acquisition, CMC and SYH. All the authors have read and agreed to the published version of the manuscript.

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Correspondence to Sheng-Yang Huang.

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Yang, LY., Chou, CM., Huang, SY. et al. Successful rescue pneumovesicoscopic surgery for post-Deflux® vesicoureteral junction obstruction. Pediatr Surg Int 39, 254 (2023). https://doi.org/10.1007/s00383-023-05538-3

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