Wang Peter Zhan Tao, Abdelhalim Ahmed, Walia Arman, Wehbi Elias, Dave Sumit, Khoury Antoine
Department of Surgery, Division of Urology, London Health Sciences Centre, Western University, London, ON, Canada.
Department of Urology, Children's Hospital of Orange County, University of California, Irvine, CA, United States.
Can Urol Assoc J. 2019 May;13(5):E119-E124. doi: 10.5489/cuaj.5589. Epub 2018 Nov 5.
Variability in the success rates for the endoscopic correction of vesicoureteral reflux (VUR) has prompted a debate regarding the use of routine postoperative voiding cystourethrogram (VCUG). This study examines the predictive performance of intraoperative mound morphology (IMM) and the presence of a postoperative ultrasound mound (PUM) on radiologic success, as well as investigates the role of using these two predictive factors as a composite tool to predict VUR resolution after endoscopic treatment.
This retrospective study included children with primary VUR who underwent endoscopic correction with a double hydrodistension-implantation technique (HIT) and dextranomer/hyaluronic acid copolymer. IMM was assessed intraoperatively. The presence of a PUM and VUR resolution were assessed by postoperative ultrasound (US) and VCUG, respectively. Radiologic success was defined as VUR resolution.
A total of 70 children (97 ureters) were included in the study. The overall radiologic success rate was 83.5%. There was no statistically significant association between radiologic success and IMM (85.2% with excellent and 87.5% with "other" morphology; p=0.81). The sensitivity and specificity of PUM for radiologic success in this study was 98% and 71%, respectively, while the sensitivity and specificity of the combined prediction model were 81.9% and 85.7%, respectively.
We objectively demonstrated that IMM was a poor predictor of radiologic success and should be used with caution. In addition, the performance of a combined prediction model was inferior to the presence of a PUM alone. As such, selective use of postoperative VCUG may be guided solely by the presence of a PUM.
膀胱输尿管反流（VUR）内镜矫正成功率的差异引发了关于术后常规排尿性膀胱尿道造影（VCUG）使用的争论。本研究考察了术中隆起形态（IMM）和术后超声隆起（PUM）对放射学成功的预测性能，并研究了将这两个预测因素作为综合工具预测内镜治疗后VUR消退的作用。
这项回顾性研究纳入了采用双重水扩张植入技术（HIT）和葡聚糖omer/透明质酸共聚物进行内镜矫正的原发性VUR患儿。术中评估IMM。分别通过术后超声（US）和VCUG评估PUM的存在和VUR消退情况。放射学成功定义为VUR消退。
本研究共纳入70名儿童（97条输尿管）。总体放射学成功率为83.5%。放射学成功与IMM之间无统计学显著关联（优秀形态者为85.2%，“其他”形态者为87.5%；p = 0.81）。本研究中PUM对放射学成功的敏感性和特异性分别为98%和71%，而联合预测模型的敏感性和特异性分别为81.9%和85.7%。
我们客观地证明IMM对放射学成功的预测较差，应谨慎使用。此外，联合预测模型的性能不如单独存在PUM。因此，术后VCUG的选择性使用可能仅由PUM的存在来指导。
