Vesicoureteral Reflux (VUR) – Endoscopic Correction
The endoscopic correction of vesicoureteral reflux (VUR) in children is a currently well-accepted therapy in many pediatric urology centers.
Endoscopic management of VUR in children since the introduction of subureteric injection of bulking substance about 30 years ago, has become a first line procedure for the interventional treatment of all grades of reflux in children in many pediatric institutions.
Currently, the bulking agent that is endoscopically injected around the ureteral opening, is a biodegradable substance. The overall success results reported in the literature after the endoscopic correction of VUR in children with the most widely used bulking agent, DX/Ha - hyaluronic acid (HA) and dextranomer (Dx) -– range between 68% and 92%, taking into consideration the reflux grade. The low VUR grades have the best results. The high VUR grades may need a second injection for a total resolution of VUR.
It is a day clinic procedure, and it is performed under general anesthesia.
The surgical correction (open surgery) is still indicated in distinguished anatomic variations of the low urinary tract and in the cases with endoscopic therapy failure.
Urolithiasis in Paediatric Patients and LASER Endoscopic Therapy
Since 2019 we have the partnership of two very experienced urologists in laser endoscopic therapy of urolithiasis at the IASO Children’s Hospital. Dr. JOHN KATAFYOTIS and Dr. STAVROS SFOUGARISTO who have founded the Athens Stone Clinic (2018), a specialized urolithiasis center in Greece. With post-graduation in endourology in many renowned centers abroad they built a significant experience in performing this minimally invasive, effective, and safe surgical procedure for the treatment of renal stones in children with minimal complication rate. We also offer a multidisciplinary management and follow up of the renal lithiasis in children with the partnership of experienced paediatric nephrologist Prof. ELENI GEORGAKI and pediatric radiology and image specialists.
The incidence of urolithiasis in the children increased nearly 5-fold in the last two decades and lately with many new cases occurring every year even in young children. The usual therapeutic options were extracorporeal shock wave lithotripsy and open nephrolithotomy or ureterolithotomy. In the recent years, alternative and modern less invasive procedures are available like mini percutaneous nephrolithotomy and ureteroscopy with flexible or semi flexible ureteroscope that allowed the use of laser for lithotripsy.
These methods are feasible in childhood and they are getting more widely used with the consistent experience learned and the use of small caliber instruments that are available nowadays. We are glad to show the benefits of using them in our little patients with urolithiasis.
Currently, the ureteroscopic lithotripsy seems to be an excellent first-line treatment for children with ureteral stones in whom conservative therapy fails, independently from primary location and size, obtaining a better result stone-free rate when compared to extracorporeal shock waving lithotripsy.