2015/03/31 by Julia B. Finkelstein, Mark V. Silva, Jennifer Ahn +5
Medicine · #Pediatric Urology and Nephrology Studies #Urological Disorders and Treatments #Kidney Stones and Urolithiasis Treatments
paper · doi:10.1016/j.juro.2015.02.2038
You have accessJournal of UrologyPediatrics: Urinary Tract Infections/Vesicoureteral Reflux1 Apr 2015MP54-15 WHAT IS THE INCIDENCE OF DEFLUX CALCIFICATION ON ULTRASOUND? Julia B. Finkelstein, Mark V. Silva, Jennifer J. Ahn, Jason P. Van Batavia, Shumyle Alam, and Pasquale Casale Julia B. FinkelsteinJulia B. Finkelstein More articles by this author , Mark V. SilvaMark V. Silva More articles by this author , Jennifer J. AhnJennifer J. Ahn More articles by this author , Jason P. Van BataviaJason P. Van Batavia More articles by this author , Shumyle AlamShumyle Alam More articles by this author , and Pasquale CasalePasquale Casale More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2038AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Vesicoureteral reflux (VUR) affects approximately 1% of children. Traditionally, children with VUR underwent open ureteral reimplantation. This approach has largely been replaced by endoscopic treatment methods with use of injectable materials. Specifically, the endoscopic injection of dextranomer-hyaluronic acid (Deflux) has become widely used to treat VUR, with high reported success rates and minimal complications noted. However, there have been recent reports of implant calcifications misdiagnosed as urinary calculi. We sought to evaluate the incidence of calcification of this polymer in our pediatric population. METHODS With IRB approval, we retrospectively reviewed the charts of all pediatric patients who underwent endoscopic injection of deflux at our institution from January 1, 2011 to December 31, 2013. Twenty-two patients who underwent deflux injection into the bladder wall, bladder neck or urethra were excluded from the analysis. Postoperative ultrasounds were evaluated for the remaining children. If a hyperechogenic focus with shadowing was noted on ultrasound, it was recorded as a deflux calcification. RESULTS During the three-year study period, 76 children (25 boys, 51 girls) at a mean age of 9.1 years received endoscopic injection of Deflux. A second injection was performed in 4 children and 66 (82.5%) patients received bilateral injections. Overall, 142 ureters in total were injected. Mean follow-up was 18.8 months. Postoperative ultrasound was available in 87% of patients. In 8 children (10%), hyperechogenic foci were present and detected at a mean of 9.8 months postoperatively. One of these children became symptomatic, presenting 2.4 years after the procedure with flank pain. Ultrasound was suspicious for bilateral stones at the ureterovesical junctions. Subsequent non-contrast CT scan demonstrated coarse calcifications bilaterally without evidence of ureteral stones. None of the children who underwent repeated injection were noted to have a calcification on ultrasound. CONCLUSIONS In this series, the incidence of calcification of Deflux on postoperative ultrasound was 10%, with one symptomatic patient. Given the widespread use of Deflux for VUR, it is likely that an increasing number of both pediatric and adult urologists will be presented with this diagnostic dilemma. Therefore, it is important to keep this in mind when evaluating a patient with abdominal pain and a history of previous Deflux injection, thereby avoiding unwarranted intervention. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e670 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Julia B. Finkelstein More articles by this author Mark V. Silva More articles by this author Jennifer J. Ahn More articles by this author Jason P. Van Batavia More articles by this author Shumyle Alam More articles by this author Pasquale Casale More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...