Investigating the clinical outcomes of bulking agent injection in comparison with modified Gil-Vernet anti-vesicoureteral reflux surgery in children with high-grade reflux (4 or 5)

Abstract

Vesicoureteral reflux (VUR) is a common condition associated with childhood urinary tract infection (UTI) that can lead to chronic renal failure and hypertension. Various anti-reflux treatments were advocated, with various degrees of morbidity and success. The purpose of this study is to analyze and compare the results of modified Gil-Vernet anti-reflux surgery and bulking agent injection in children with unilateral high-grade reflux. The study involved 179 patients who underwent surgical interventions for primary VUR from February 2013 to September 2019. Data on baseline demographics, preoperative symptoms, radiological imaging studies, and postoperative outcomes were analyzed. Treatment goal was defined as when no VUR or downgrading was detected 6 months or later after the intervention. A total of 128 patients underwent modified Gil-Vernet anti-reflux surgery and 51 patients underwent dextranomer/hyaluronic acid (Dx/HA) injection with mean VUR grading of 4.3 in both groups (P = 0.687). The overall VUR resolution rates were significantly higher in modified anti-reflux surgery rather than Dx/HA injection (86% vs. 68%, P = 0.021). Dx/HA injection was associated with shorter operation time (21 ± 8 min vs. 57 ± 11 min, P = 0.01), and shorter hospital stay (0.34 ± 0.22 days vs. 3.50 ± 0.50 days, P < 0.001). No major complications were identified in both groups. Dx/HA injection has a significantly shorter operation time, lower postoperative analgesic usage, and shorter hospital stay, modified Gil-Vernet anti-reflux surgery is associated with significantly higher VUR downgrading and resolution rates than Dx/HA injection, particularly in the higher grade VUR.