Is real time 3d-ultrasonography in synopsis with clinical follow-up studies a sufficient tool for surveillance after endoscopic treatment of children with vesicoureteral reflux?
Purpose There are still no guidelines for the follow up of patients after endoscopic treatment of vesicoureteral reflux (VUR). We evaluated real time 3D-ultrasonography (4D-US) in synopsis with the clinical course as a possible protocol in the follow up of these children. Material and Methods We retrospectively reviewed 178 children (296 ureters, median age 41 months) who underwent endoscopic therapy with Deflux®. VUR grade was II or III. Real-time 3-D ultrasound was done one day, 3, 9 and 18 months after the procedure using a GE Voluson® 730 system recording the position and size of the depot. At each visit a complete urological anamnesis was done. In case of a non orthotopic position of the depot a voiding cystourethrogram (VCUG) was performed. Results In 93% of the ureteral units the depot could be detected in the same orthotopic position after 3, 9 and 18 months. None of these children suffered from a UTI in the follow up. In 12 children there was a shifting of the depot indicating a possible insufficient therapy. 8 of these patients showed a positive VCUG, of them 4 patients sustained a UTI. The symptomatic children obtained an open reflux surgery; the 4 asymptomatic children were treated with a second endoscopic therapy. Conclusions 4D-US in the synopsis with the clinical course is a sufficient tool in the follow up of children after endoscopic treatment of low grade VUR. In case of an orthotopic position of the Deflux® depot in the follow up and absent UTI's no further invasive diagnostic with VCUG is indicated.