Utility of an intra-operative cystogram with a simulated voiding phase after endoscopic treatment of vesicoureteral reflux.

Purpose: To assess the utility of intraoperative cystogram with a simulated voiding phase after endoscopic treatment of vesicoureteral reflux (VUR).
Methods: From September 2003 to June 2005, 24 children underwent injection of deflux for the treatment of VUR. A total of 38 ureters were treated. After deflux injection, our most recent 14 patients had a cystogram with simulated voiding phase to assess for the presence of VUR. All patients were scheduled for a voiding cystourethrogram (VCUG) three months postoperatively to assess for persistent reflux. The surgery was considered a success only if patients did not demonstrate reflux on their postoperative VCUG.
Results: Of the 24 patients undergoing deflux injection, 14 had complete resolution of their VUR. Eight patients had persistent VUR and 2 patients were lost to follow-up. A total of 38 ureters were injected. Twenty-seven ureters no longer refluxed, while 8 ureters continued to reflux and 3 ureters were lost to follow-up. Fourteen patients had an intra-operative cystogram with simulated voiding phase. The intra-operative cystogram with simulated voiding phase was negative in all patients except for one patient who demonstrated the presence of de novo contralateral VUR. There were 7 true negatives on intra-operative cystogram with a simulated voiding phase and 6 false negatives.
Conclusions: Our results of endoscopic treatment of VUR compare well to the results reported by others in the literature. An intra-operative cystogram may demonstrate unsuspected contralateral reflux but does not appear to predict the success of deflux injections.