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CUHK Pioneers a New Minimally Invasive Treatment Protocol for
Traditionally, treatment options consist of long-term antibiotic prophylaxis or open bladder surgery. Apart from the agony to have to take medications everyday, and the need for repeated painful investigations like micturating cystourethrogram (MCUG) over an indefinite period, up to 40% of patients on antibiotic prophylaxis would develop breakthrough UTI, with many developing new kidney scarring afterwards, and ultimately ending up with surgery after. Alternatively, the traditional open bladder surgery is an invasive and traumatic procedure. Although it boasts the advantage of a high cure rate of over 90%, the operation necessitates a big abdominal and open bladder incision, and is associated with significant post-operative pain and morbidity, and lengthy hospital stay. At the Chinese University of Hong Kong, the Division of Paediatric Surgery and Paediatric Urology has pioneered a completely new management algorithm with minimally invasive treatment of VUR that provides complete cure for all grades yet involving only endoscopic treatment without necessitating any open surgery. This minimally invasive surgical treatment includes 1) pneumovesical ureteric reimplantation and 2) endoscopic sub-ureteric injection. The first technique of minimally invasive surgery via carbon dioxide insufflation of the bladder (pneumovesicum) was pioneered at the Chinese University of Hong Kong. Since 2000, we have successfully applied this pneumovesical technique for severe grade reflux (Grade IV Bilateral to Grade V) in nearly a hundred patients, achieving 99% cure rate. This technique allows anti-reflux surgery to be performed without opening up of the bladder and does not necessitate any indwelling ureteric catheter, hence significantly reducing post-operative pain and bladder spasm. Patients are up and about within a few hours after surgery and can be discharged home in 24 hours with minimal pain and discomfort. The pneumovesical technique is used in combination with the technique of endoscopic sub-ureteric injection. The latter technique has been applied mainly for milder grade (Grade II to Grade III and Grade 4 Unilateral) reflux attaining 96% cure rate. This injectable agent is a copolymer of dextranomer and hyaluronic acid (Dx/HA), it is biodegradable. Like surgery, this offers effective cure for VUR, and eliminates the risk for progressive kidney damage in children with VUR, eliminating risk or progressive renal damage in children with VUR. In addition, this treatment is totally minimally invasive, does not involve any wounds and can be carried out safely as a day procedure. The new treatment algorithm provides definitive surgical treatment that aims at an early cure and higher success rate. It is easily acceptable by patients and parents as there is much less trauma to the child, and it offers a high cure rate alleviating the need for long-term follow-up of the patient with radiological investigations and antibiotic treatment. |