Intraoperative ultrasound-assisted approach for endoscopic treatment of...

Good afternoon. My name is Patricia Gargoyo. I'm a pediatric urologist at the Mayo Clinic, and today we will be discussing intraoperative ultrasound assisted approach for endoscopic treatment of vesicoureteral reflux in children by Zambaidi and colleagues. This was a study analyzing a cohort of children who were treated for moderate to high grade primary vesicoureteral reflux with dextronomer hyaluronic acid. The study design was as follows. Patients that were going injection underwent a concomitant intraoperative ultrasound evaluation by a trained radiologist to evaluate things like mound location, mound height, and mound classification, which the authors described as poor, good, and optimal based on several criteria. Subsequent to this, at 3 months, all patients underwent a VCUG and a renal bladder ultrasound and a subsequent follow-up renal bladder ultrasound at 1 year. This was done by a blinded radiologist to the initial study. These figures show several. Schematics of both the intraoperative injection as well as the real-time intraoperative ultrasounds. The result was as follows. It looked at 26 patients amounting to 41 ureters. All of these underwent endoscopic injections 61% with the double hit technique and 39% with the sting technique. Overall success per ureter radiographically was 75.6%, and multivariate regression showed a correlation between success and mound height, which was consistent with previous studies. A mound height of greater or equal to 9.8 millimeters was a predictor of reflux resolution. Based on these studies, the authors came up with a follow-up algorithm in which patients with high resolution rates based on favorable mound anatomy underwent simple clinical monitoring or ultrasound scan without a VCUG. I hope you enjoyed today's urology review of this article. Have a great day.