UroToday - Dr. James Elmore, et al. from Atlanta evaluated, to see if there was a difference in clinical outcome, two groups of children who were cured of reflux with either open surgery or Deflux injection. Forty-three patients underwent Deflux and thirty-three open reimplantation for vesicotueral reflux. The group defined urinary tract infection as any culture that grew more than 10(5) colonies of a single organism, with symptoms typical of cystitis. A febrile urinary tract infection was defined as a previously described cystitis type of infection accompanied by a temperature greater than 101.5F.

The group found that the incidence of urinary tract infection after open surgery was significantly higher than that observed following successful Deflux injection. They found that 38% of the patients who had open surgery did have recurrent UTIs. Those who had a Deflux injection had a recurrent UTI rate of only 15%. A febrile urinary tract infection occurred in 24% of the children who underwent open surgery and in 5% of those who underwent Deflux injection. Hospital readmissions were only seen in children who underwent open surgery.

The group concluded that children successfully cured of reflux with Deflux injection had a lower incidence of febrile and nonfebrile urinary tract infections compared to those cured with open surgery in their experience. This is an interesting finding and some may argue that the open surgery can add to the dysfunctional voiding of patients - especially in the early postoperative period. It is an interesting observation, but one must also evaluate why open surgery was required in those children in the first place. Was it because of a higher grade of reflux? Was it the higher rate of recurrence of febrile urinary tract infections? Was it because of renal scarring? All such patients are at higher risk and are typically treated with open surgery rather than injection therapy.

If they are at increased risk, is it truly because of bladder dysfunction or is it attributable to the procedure? In my opinion, most likely it will be bladder driven, and have nothing at all do with the procedure - but everything to do with the patients themselves.

Elmore JM, Kirsch AJ, Heiss EA, Gilchrist A, Scherz HC
J Urol. 2008 Jun;179(6):2364-7
10.1016/j.juro.2008.01.149

Reported by UroToday Medical Editor Pasquale Casale, MD

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