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Paediatric Surgery
Endoscopic Treatment of Vesicoureteral Reflux
Built from Puri — Pediatric Surgery and Pediatric Urology
What’s inside
7 sections · 54 slides
The Problem
What reflux is and why it must be treated
- What is vesicoureteral reflux?
- The valve that normally stops reflux
- How common is reflux?
- Why reflux matters: infection meets the kidney
- Reflux nephropathy: the long-term stakes
- Reflux runs in families
- Will reflux resolve on its own?
- The limits of antibiotic prophylaxis
- Surgery works, but it is a big step
- The birth of endoscopic treatment
When to Offer It
Choosing the right patient
- Core indications
- Expanded indications: the harder cases
- Contraindications
Tools and Materials
The scope, the catheter, and the bulking agent
- The cystoscope and the Puri catheter
- Cystoscope with the Puri injection catheter
- Deflux: what the bulking agent is made of
- Bulking agents used over the years
The Procedure
Setup and injection techniques
- Operative setup
- Four injection techniques
- The STING procedure: step by step
- Endoscopic steps of subureteral injection
- Building the volcano and the nipple
- HIT: hydrodistention implantation
- When one injection is not enough
- STING versus HIT: which works better?
After the Procedure
Recovery, follow-up, and the imaging debate
- Postoperative care
- The VCUG controversy
- Voiding cystourethrogram before and after treatment
- Long-term follow-up
Results and Complications
How well it works and what can go wrong
- A safe procedure
- Resolution rate by reflux grade
- If it fails, just repeat it
- The harder cases
- Febrile UTIs after successful correction
- Obstruction of the ureterovesical junction
- Why late obstruction happens
The Bigger Picture
Where endoscopic treatment fits
- First-line therapy for many children
- Cost and what parents choose
- Future directions
- Key takeaways
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- Pediatric Surgery and Pediatric Urology