Ureteric patency after Deflux® injection for the treatment of vesicoureteric reflux in children confirmed by a novel epidural catheter-assisted endoscopic technique.
PURPOSE
We present EDCAT (epidural catheter-assisted Deflux(®) treatment) for treating vesicoureteral reflux (VUR) and confirming ureteric patency after Deflux(®) treatment.


METHODS
We treated 147 ureters in 101 children (M:F 62:39; VUR ≤ grade III: n = 72; VUR ≥ grade IV: n = 75) using EDCAT between 2011 and 2014. EDCAT involves injecting 1-3 mL of diluted indigo carmine solution through an epidural anesthesia catheter inserted into the Deflux(®)-treated ureter and observing for up to 15 min to confirm patency.


RESULTS
For EDCAT, mean age was 4.9 years and mean operative time was 30.1 ± 12.1 min; overall cure of VUR after initial treatment was 87.7 % for VUR grades I-V, 88.9 % for VUR ≤ grade III, and 86.6 % for VUR ≥ grade IV; VUR was cured in 129/147 after 1 treatment, 7/18 after 2 treatments, 7/11 after 3 treatments, and persistent in 4/4. We experienced 1 case of obstruction after an EDCAT catheter was removed before confirming patency. EDCAT catheters were left overnight in 2 ureters in 2 cases when patency could not be confirmed after 15 min to prevent obstruction. Both did not develop obstruction. Four ureters with recurrence of VUR (all grade ≤ II) are being observed.


CONCLUSION
EDCAT allows ureteric patency to be confirmed immediately and prevents obstruction.
['Okawada|Manabu|M|', 'Shibuya|Soichi|S|', 'Doi|Takashi|T|', 'Miyano|Go|G|', 'Koga|Hiroyuki|H|', 'Lane|Geoffrey J|GJ|', 'Okazaki|Tadaharu|T|', 'Yamataka|Atsuyuki|A|']
D057785:Catheters D002675:Child, Preschool D004396:Coloring Agents D003911:Dextrans D004824:Epidural Space D005260:Female D006801:Humans D006820:Hyaluronic Acid D007203:Indigo Carmine D008297:Male D016896:Treatment Outcome D014513:Ureter D018666:Ureteroscopy D014567:Urography D014718:Vesico-Ureteral Reflux
Deflux® Vesicoureteral reflux Epidural catheter