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Vesicoureteral reflux (VUR) is an abnormality frequently seen at a complete duplex system (DS). Operational correction is required and completed after the neonatal period when symptoms occur. This study aimed to evaluate the efficacy of Vantris and a need for additional surgery in children with DS VUR in a multicenter study. We performed retrospective analysis of prospectively acquired data, from 2009 to 2018, on 172 patients with a mean age of 3 years with VUR into either upper or lower moiety of the DS who underwent endoscopic correction utilizing Vantris at five centers worldwide. All patients were with primary VUR. The median follow-up was 7 years. Reflux was corrected in 122 patients (70%) after the first injection and 35 patients (20%) after the second injection. 15 patients (9%) failed endoscopic correction and required ureteral reimplantation. 13 patients suffered afebrile urinary tract infection, and 9 patients developed febrile urinary tract infection (UTI). 3 patients required partial nephrectomy of the poorly or non-functioning refluxing moiety following the failure of endoscopic correction. Our data shows that Vantris injection provides a high reflux resolution in a DS with VUR. Successful VUR resolution might spare some patients associated with VUR poorly functioning moieties further surgery.

We present a long-term follow-up of patients who underwent VUR correction with polyacrylate polyalcohol copolymer (PPC) injection with an emphasis on UVJ obstruction and urinary tract infection. During 2009–2012, 157 children (106 girls and 51 boys) with mean age of 4.8 ± 2.8 years (mean ± SD) underwent endoscopic correction of VUR using PPC. VUR was unilateral in 74 patients and bilateral in 83, comprising 240 renal reflux units (RRU). Of these, primary VUR was present in 197 RRU (82.1%) and 43 (17.9%) were complex cases. Median follow-up was 7 years (range 6–10 years). Average volume of PPC was 1.2 ml (range 0.6–1.8 ml) Reflux was corrected in 222 RRU (92.5%) after a single injection, and in 10 RRU (4.2%) after the second injection. In RRU 7 (2.9%), reflux downgraded to Grade I and II, and they were taken off antibiotic prophylaxis. One patient (0.4%) failed endoscopic correction and required ureteral reimplantation (UR). 11 (4.6%) RRU developed UVJ obstruction, of which 9 (3.8%) required UR. All patients developed obstruction between 1 and 2 years after injection. Nineteen (12.1%) patients developed low UTI, and 12 (7.6%) patients developed febrile UTI during follow-up. None of these patients demonstrated reflux recurrence. Our data indicate that endoscopic correction utilizing PPC does not increase the risk of obstruction during long-term follow-up.

The use of double J stents (DJS) is common practice during robotic reconstructive surgeries in the pediatric population. Some studies claimed that a small stent diameter is prone to obstruction and migration, thus might increase the number of post-op complications. The aim of this study was to evaluate whether the use of a small stent size leads to higher complication rate following robotic reconstructive surgery in children. We have retrospectively reviewed the medical files of patients, who underwent reconstructive robotic surgery with insertion of 3Fr or 4Fr DJS over a 3-year period, from two medical centers. The data included demographics, operation type, DJS size, post-op complications and duration of hospital stay. The study included 47 patients, 33 (70.2%) were male. The mean age was 34 months (range 3–192 months). 3Fr DJS was used in 13 (27.7%) patients and 4Fr stent was utilized in the remaining 34 (72.3%) children. 3Fr stents were more frequently used in younger children (14 vs 42 months, p