V571: Pump Irrigation as an Adjunct to Endoscopic Treatment of Vesicoureteral Reflux: A Better Way to a Happy HIT

Video

Introduction and Objectives
Vesicoureteral reflux (VUR) affects up to 1% of children. While there is some controversy in regard to intervention, endoscopic submucosal intra-ureteric injection of Deflux™ (dextranomer/hyaluronic copolymer) has been shown to have high success rates and durable results. Modifications to initial STING (subureteric injection of Teflon) has led to better coaptation of the ureteral tunnel with the HIT (hydrodistention implantation technique) and the Double HIT procedures. We present a modification to hydrodistention that addresses some of the difficulties such as rapid bladder filling during HIT procedures.

Methods
Intermittent pump irrigation with the Single Action Pumping System (SAPS™, Boston Scientific, Natick, MA) was used to attain hydrodistention of the intramural ureter for HIT/Double HIT injection of Deflux™.

Results
Hydrodistention of the intramural ureter was obtained with this modality to facilitate visualization of the intramural ureter. This allowed visual identification of the optimal injection site of HIT/Double HIT in a controlled fashion.

Conclusions
We present a modification to the hydrodistention aspect of HIT technique that addresses some of the challenges of continuous irrigation in patients with small bladder capacity. Intermittent pump irrigation provides greater control of ureteral hydrodistention while preventing bladder overdistention. This allows the ability to visually evaluate treatment progress of the intramural ureter throughout the injection process. Future studies could focus on the role of contrast infusion via pump irrigation with fluoroscopy to further evaluate efficacy at completion of endoscopic treatment of VUR.

Funding: none