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Minerva Urology and Nephrology 2021 Jun 11

DOI: 10.23736/S2724-6051.21.04430-X

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Current trends in 2021 in surgical management of vesico-ureteral reflux in pediatric patients: results of a multicenter international survey on 552 patients

Ciro ESPOSITO 1, Atsuyuki YAMATAKA 2, Francois VARLET 3, Marco CASTAGNETTI 4, Aurelien SCALABRE 3, Laurent FOURCADE 5, Quentin BALLOUHEY 5, Simona NAPPO 6, Maria ESCOLINO 1

1 Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy; 2 Division of Pediatric General & Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan; 3 Division of Pediatric Surgery, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France; 4 Division of Pediatric Urology, Medical University of Padua, Padua, Italy; 5 Division of Pediatric Surgery, CHU de Limoges, Hopital de la Mère et de l'Enfant, Limoges, France; 6 Division of Pediatric Urology, Regina Margherita Hospital, Turin, Italy


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BACKGROUND: The selection of best surgical approach for treatment of vesico-ureteral reflux (VUR) in the pediatric population remains debated. This study aimed to report the results of a multicenter survey about the current trends in surgical management of pediatric VUR.
METHODS: An online questionnaire-based survey was performed, with participation of 6 international institutions. All children (age <18 years) affected by primary III-V grade VUR, who were operated over the last 5 years, were included. The incidence of each VUR intervention, patients’ demographics and outcomes were analyzed.
RESULTS: A total of 552 patients (331 girls), with a median age of 4.6 years (range 0.5-17.6), were included. Deflux® injection (STING) was the most common technique (70.1%). The multicenter success rate after single treatment was significantly lower after STING (74.4%) compared with the other treatments [p=0.001]. Persistent VUR rate was significantly higher after STING (10.8%) compared with the other treatments [p=0.03]. Choosing endoscopy over surgery mean reducing Clavien Dindo grade 2 complications by 5% but increasing redo procedure rate by 7%. STING was the most cost-effective option.
CONCLUSIONS: This survey confirmed that the choice of the technique remains based on surgeon’s preference. Deflux® injection currently represents the first line therapy for primary VUR in children and the role of surgical ureteral reimplantation is significantly reduced. STING reported acceptable success rate, less post-operative complications and lower costs but higher failure and re-operation rates and related costs compared with the other surgical approaches. The adoption of laparoscopy and robotics over open reimplantation remains still limited.


KEY WORDS: Vesico-ureteral reflux; Reimplantation; Robot; Endoscopy; Children

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