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Endoscopic treatment of vesicoureteral reflux after kidney transplantation: outcomes and predictive factors of clinical and radiological success

  • Urology - Original Paper
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Abstract

Purpose

This study aimed to identify and describe the outcomes of different endoscopic treatments and the predictive factors affecting success in the treatment of symptomatic vesicoureteral reflux (VUR) after kidney transplantation.

Methods

Patients who had undergone endoscopic injection treatment for symptomatic VUR detected by VCUG with at least 1-year follow-up were included in the study. Patients with dysfunctional and/or obstructive voiding patterns were excluded from the study. We retrospectively evaluated the patient’s characteristics, operative information about the type of injection (one, two, or four-point) and the bulking agent (DX-HA, PPC), and perioperative data. Clinical success was defined as no febrile UTI, and radiological success was defined as the absence of VUR in VCUG 3 months after the operation. Clinical success, radiological success, and encountered complications were statistically analyzed.

Results

A total of 76 patients were included in this study. The one-point, two-point, and four-point injection technique was applied to 32 (42.1%), 13 (17.1%), and 31 (40.7%) of patients, respectively. PPC and DX-HA were used as bulking agents in 54 (71.1%) and 22 (28.9%) patients, respectively. The clinical success rate was 73.7% (n = 56). In logistic regression analysis, a significant efficacy of the four-point technique was observed in the univariate analysis of clinical success (p = 0.042). The radiological success rate was 40.8% (n = 31). In the logistic regression analysis, DX-HA and PPC radiological success was attained in 4 (18.1%) and 27 (50%) patients, respectively (p = 0.01). Ureterovesical junction (UV) stricture developed in 5 (6.5%) patients. There was no difference between injection techniques and bulking agents in terms of the development of UV stricture (p = 0.32; p = 0.08).

Conclusion

The success of endoscopic treatment in patients with VUR after kidney transplantation can be increased by multiple injections. Furthermore, PPC can be used to obtain a higher radiological success.

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Funding

All authors declare no any funding for this study.

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Authors and Affiliations

  1. Department of Urology, Biruni University, Istanbul, Turkey

    Nusret Can Çilesiz, Özkan Onuk & Barış Nuhoğlu

  2. Department of Urology, Istanbul Koç University, Istanbul, Turkey

    Arif Özkan

  3. Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey

    Arif Kalkanlı & Cem Tuğrul Gezmiş

  4. Department of Urology, Biruni University, Istanbul, Turkey

    Nusret Can Çilesiz

Authors
  1. Nusret Can Çilesiz
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  2. Özkan Onuk
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  3. Arif Özkan
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  4. Arif Kalkanlı
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  5. Cem Tuğrul Gezmiş
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  6. Barış Nuhoğlu
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Contributions

Research conception and design: NCC, OO. Data acquisition: NCC,OO,BN. Statistical analysis: AO, AK. Data analysis and interpretation: NCC, OO, BN. Drafting of the manuscript: NCC, CTG. Critical revision of the manuscript: AK, CTG, BN. Administrative, technical, or material support: AO, CTG. Supervision: OO, BN. Approval of the final manuscript: NCC, AO.

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Correspondence to Nusret Can Çilesiz.

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Çilesiz, N.C., Onuk, Ö., Özkan, A. et al. Endoscopic treatment of vesicoureteral reflux after kidney transplantation: outcomes and predictive factors of clinical and radiological success. Int Urol Nephrol 54, 1023–1029 (2022). https://doi.org/10.1007/s11255-022-03152-1

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  • DOI: https://doi.org/10.1007/s11255-022-03152-1

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