Are adults just big kids? A collaborative approach to the management of vesicoureteric reflux in adults: A case series and systematic review
BAUS ePoster online library. Murchison L. 11/11/20; 304265; P13-5 Disclosure(s): No relationship with corporate organizations, such as grant/research support, stock shareholder, honorariums, consultant work, etc
Ms. Louise Murchison
Ms. Louise Murchison
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Are adults just big kids? A collaborative approach to the management of vesicoureteric reflux in adults: A case series and systematic review

Murchison L1, Seager R1, Doherty R1, Webb R1, Mathur A1
1Norfolk and Norwich University Hospital, United Kingdom

Introduction:
Vesicoureteric reflux (VUR) is common within the paediatric population. It occurs within less than 4.4% of adults and does not display the same rate of spontaneous resolution. Surgical management is required in adults to prevent sequelae ranging from recurrent UTIs to end-stage renal failure. The standard management of VUR in adults has historically involved ureteral reimplantation, whilst endoscopic management is the first-line management in children.

Methods:
Retrospective analysis (2019-2009) was performed of our collaborative (paediatric and adult urology) institutional experience of VUR management in adults, using endoscopic injection of dextransomer/hyaluronic acid copolymer (Deflux). Systematic review of the literature was also performed.

Results:
The records of 7 patients, all female, aged 19-54 were reviewed. Three initially developed symptoms of VUR in childhood. Seven patients had presenting symptoms of recurrent UTI/pyelonephritis, 3 had elevated creatinine and 1 stage III chronic kidney disease. Two patients had previously undergone bilateral ureteral reimplantation for management of VUR. One patient had developed reflux into the ureteric stump following nephrectomy. Four patients required 1 injection of deflux for resolution of symptoms. In the 3 patients requiring >1 injection, symptomatic improvement ranged from 9 months-6 years. Two patients had recurrent UTIs post-deflux. Two had reflux noted on post-operative MAG3 scan. No patients developed complications such as obstruction of VUJ or development of new contralateral reflux. None required subsequent reimplantation.

Conclusions:
Endoscopic management of VUR avoids the risks and morbidities associated with the extensive abdominal surgery involved in performing reimplantation, whilst providing physiological and symptomatic improvement.
Are adults just big kids? A collaborative approach to the management of vesicoureteric reflux in adults: A case series and systematic review

Murchison L1, Seager R1, Doherty R1, Webb R1, Mathur A1
1Norfolk and Norwich University Hospital, United Kingdom

Introduction:
Vesicoureteric reflux (VUR) is common within the paediatric population. It occurs within less than 4.4% of adults and does not display the same rate of spontaneous resolution. Surgical management is required in adults to prevent sequelae ranging from recurrent UTIs to end-stage renal failure. The standard management of VUR in adults has historically involved ureteral reimplantation, whilst endoscopic management is the first-line management in children.

Methods:
Retrospective analysis (2019-2009) was performed of our collaborative (paediatric and adult urology) institutional experience of VUR management in adults, using endoscopic injection of dextransomer/hyaluronic acid copolymer (Deflux). Systematic review of the literature was also performed.

Results:
The records of 7 patients, all female, aged 19-54 were reviewed. Three initially developed symptoms of VUR in childhood. Seven patients had presenting symptoms of recurrent UTI/pyelonephritis, 3 had elevated creatinine and 1 stage III chronic kidney disease. Two patients had previously undergone bilateral ureteral reimplantation for management of VUR. One patient had developed reflux into the ureteric stump following nephrectomy. Four patients required 1 injection of deflux for resolution of symptoms. In the 3 patients requiring >1 injection, symptomatic improvement ranged from 9 months-6 years. Two patients had recurrent UTIs post-deflux. Two had reflux noted on post-operative MAG3 scan. No patients developed complications such as obstruction of VUJ or development of new contralateral reflux. None required subsequent reimplantation.

Conclusions:
Endoscopic management of VUR avoids the risks and morbidities associated with the extensive abdominal surgery involved in performing reimplantation, whilst providing physiological and symptomatic improvement.
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