Journal List > J Korean Med Sci > v.28(9) > 1022078

TOOLS
de Jesus: Resolution of UTIs Post Deflux Injections for VUR May Be due to the Cure of BBD
Correspondence

Journal of Korean Medical Science 2013; 28(9): 1410.

Published online: 28 August 2013

DOI: https://doi.org/10.3346/jkms.2013.28.9.1410

Resolution of UTIs Post Deflux Injections for VUR May Be due to the Cure of BBD

Lisieux Eyer de Jesus

TCBC/T-CIPE

Department of Pediatric Surgery/Urology, Hospital Universitário Antônio Pedro e Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil.

1Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

2Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.

3Department of Urology, Armed Forces Capital Hospital, Seongnam, Korea.

Address for Correspondence: Lisieux Eyer de Jesus, TCBC/T-CIPE, Department of Pediatric Surgery/Urology, Hospital Universitário Antônio Pedro e Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil. lisieux@uol.com.br

© 2013 The Korean Academy of Medical Sciences.

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
To the Editor:
I read the paper "Clinical Value of Persistent but Downgraded Vesicoureteral Reflux after Dextranomer/Hyaluronic Acid Injection in Children" with interest (1).
However, I think that you failed to consider an important variable/bias: the fact that deflux injections may resolve bladder bowel dysfunction (BBD). This has been repetitively mentioned in Swedish papers from G Lackgren group and a theoretical basis has been developed by our group (Jesus, LE; Borges, PF. Severe vesico-ureteral reflux and urine sequestration: mathematical relations and urodynamic consequences. ArXiv:a902.0603v2 [physicsmed. ph]3Feb2009, available at http://eprintweb.org/S/article/physics/0902.0603).
It would be very interesting to study whether the persistence or not of BBD symptoms was related to the incidence of postoperative UTIs. Specifically, an analysis of the BBD subgroup would be appropriate. This might result in a very interesting paper. Were the reduced indexes of infection in the persistent reflux population that demonstrated BBD previously to the deflux injection related to the reduction of reflux indexes or to the resolution of BBD?
Congratulations for your great paper!
Yours

References

1. Baek M, Kang MY, Lee HE, Park K, Choi H. Clinical value of persistent but downgraded vesicoureteral reflux after dextranomer/hyaluronic acid injection in children. J Korean Med Sci. 2013; 28:1060–1064.
Minki Baek1, Min Young Kang2, Hahn-Ey Lee2, Kwanjin Park2, Hwang Choi3

TCBC/T-CIPE

Department of Pediatric Surgery/Urology, Hospital Universitário Antônio Pedro e Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil.

1Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

2Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.

3Department of Urology, Armed Forces Capital Hospital, Seongnam, Korea.

Address for Correspondence: Hwang Choi, MD. Department of Urology, Armed Forces Capital Hospital, Seongnam, Korea. Tel: +82.31-725-6247, Fax: +82.31-706-0987, hchoimd@gmail.com

The Author Response:
In children who undergo dextranomer/hyaluronic acid (Dx/HA) injection, it is clear that the change of bladder bowel dysfunction (BBD) affects the incidence of postoperative febrile urinary tract infection (UTI)s. However, evidence whether injection treatment itself improves BBD is still weak. The study reported by Läckgren et al. (1) was designed retrospectively. They investigated postoperative BBD in 54 patients 7-12 yr after Dx/HA injection treatment. They used nonstandardized questionnaires by mail. In our opinion, a prospective, randomized trial is mandatory to demonstrate the relationship between Dx/HA injection and bladder dysfunction.
In our study, the number of febrile UTI episodes decreased after Dx/HA injection, which might have been affected by the improvement of BBD. Unfortunately, due to the retrospective nature of our study, we could not analyze the indexes of postoperative BBD in the persistent reflux population that demonstrated BBD.

References

1. Läckgren G, Sköldenberg E, Stenberg A. Endoscopic treatment with stabilized nonanimal hyaluronic acid/dextranomer gel is effective in vesicoureteral reflux associated with bladder dysfunction. J Urol. 2007; 177:1124–1128.
TOOLS
Similar articles