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Published online before print June 23, 2004, 10.1148/radiol.2322030551
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(Radiology 2004;232:390-397.)
© RSNA, 2004

Pediatric Imaging

Endoscopic Treatment of Vesicoureteral Reflux with Autologous Chondrocytes: Postoperative Sonographic Features1

Harriet J. Paltiel, MD, David A. Diamond, MD, David Zurakowski, PhD, Laura A. Drubach, MD and Anthony Atala, MD

1 From the Departments of Radiology (H.J.P., L.A.D.), Urology (D.A.D., A.A.), and Biostatistics (D.Z.), Children’s Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115. Received April 10, 2003; revision requested June 25; final revision received December 16; accepted January 29, 2004. Address correspondence to H.J.P. (e-mail: harriet.paltiel@childrens.harvard.edu).

PURPOSE: To analyze sonographic imaging features of renal collecting systems, ureters, and bladder in 32 children after endoscopic treatment of vesicoureteral reflux with autologous chondrocytes and to determine whether any features are associated with persistent reflux.

MATERIALS AND METHODS: Sonograms obtained at mean intervals of 1.4 and 12 months after treatment were compared with cystograms obtained at mean intervals of 2.7 and 12 months. Sonograms were analyzed for chondrocyte mound contour and volume, changes in mound volume over time, and presence of hydroureteronephrosis. Mean differences in mound volume were detected with paired t tests in 14 patients with early and late sonograms available for review.

RESULTS: Early cystograms and sonograms were available for 25 of 32 patients (45 of 56 treated ureters). Reflux occurred in 16 of 45 ureters. In 16 ureters, chondrocyte mounds were absent in six, unilobed in seven, and multilobed in three. In 29 treated ureters without reflux, mounds were unilobed in 28 and multilobed in one. Three patients had mild hydronephrosis and one had distal hydroureter; these conditions resolved. Late cystograms and sonograms were available in 18 of 22 patients (30 of 38 treated ureters). Reflux occurred in seven of 30 ureters. In seven ureters, mounds were unilobed in five and multilobed in two. In 23 treated ureters without reflux, mounds were unilobed in 21 and multilobed in two. One patient had mild hydronephrosis that resolved. In 14 patients with early and late sonograms available for review, mean mound volume in late group (0.37 cm3± 0.25 [standard deviation]) was significantly smaller than that in early group (0.56 cm3± 0.39; P = .004, paired t test).

CONCLUSION: Absence of chondrocyte mound or presence of multilobed mound contour was associated with persistent reflux. Mean mound volume decreased over time. Treatment-induced hydroureteronephrosis was uncommon and self-limited.

© RSNA, 2004

Index terms: Bladder, abnormalities, 83.85 • Bladder, US, 83.1298 • Ultrasound (US), in infants and children, 82.1298, 83.1298 • Ureter, interventional procedures, 82.1269 • Ureter, reflux, 82.85