A Numerical Study to Precise the Estimation of the “Good” Mound Height in Endoscopic Treatment of VUR


Objective: To ascertain the technique and volume of injection increasing the success rate of endoscopic VUR treatment, we develop a novel method to numerically describe the relationship between intramural ureter anatomy, intravesical pressure, and the theoretical mound height needed for adequate treatment. Methods: The main purpose of this study is to construct a finite element simulation of intramural ureter and injected mound which aims to numerically define the relationship between indexes which have influence in VUR endoscopic treatment. Using linearization software and numerically simulation data, the relationship between effective indexes has been derived. Results: By linearization of the effective parameters of different finite element models, the relationship between effective parameters in filling phase is derived as: H (m) = 0.003467 (m) + 0.7864D (m) + 0.000233. This equation depicts adequate injected mound height as a function of internal diameter and intramural length, H = f(L, D). Conclusion: Using numerical simulation, we introduced the novel formula to predict the height of injected mound in endoscopic VUR treatment. As a result of this study, in order to increasing the success rate of this treatment, the ratio of mound height to intramural ureter diameter should be approximately 78%.

Share and Cite:

Shirazi, M. , Jahanabadi, Z. , Hooshyar, Z. , Mortazavinia, Z. , Mehdizadeh, A. and Taherisadr, M. (2014) A Numerical Study to Precise the Estimation of the “Good” Mound Height in Endoscopic Treatment of VUR. Journal of Biomedical Science and Engineering, 7, 941-947. doi: 10.4236/jbise.2014.711091.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Lenaghan, D., et al. (1976) The Natural History of Reflux and Long-Term Effects of Reflux on the Kidney. Journal of Urology, 115, 728-730.
[2] Cerwinka, W.H., et al. (2010) Radiologic Features of Implants after Endoscopic Treatment of Vesicoureteral Reflux in Children. American Journal of Roentgenology, 195, 234-240.
[3] Harper, L., et al. (2008) Postoperative Cystography and Endoscopic Treatment of Low-Grade Vesicoureteral Reflux. Journal of Laparoendoscopic and Advanced Surgical Techniques, 18, 461-463.
[4] Hsieh, M.H., et al. (2010) Treatment of Pediatric Vesicoureteral Reflux Using Endoscopic Injection of Hyaluronic Acid/ Dextranomer Gel: Intermediate-Term Experience by a Single Surgeon. Urology, 76, 199-203.
[5] Elder, J.S., et al. (1997) Pediatric Vesicoureteral Reflux Guidelines Panel Summary Report on the Management of Primary Vesicoureteral Reflux in Children. The Journal of Urology, 157, 1846-1851.
[6] Perlmutter, A.E., et al. (2008) Utility of an Intra-Operative Cystogram with a Simulated Voiding Phase after Endoscopic Treatment of Vesicoureteral Reflux. The West Virginia Medical Journal, 104, 22-24.
[7] Rivilla, F. (2011) Endoscopic Treatment of Vesicoureteral Reflux in a Paediatric Surgery Ambulatory Unit. Journal of Minimal Access Surgery, 7, 132-135.
[8] Bae, Y.D., et al. (2010) Endoscopic Subureteral Injection for the Treatment of Vesicoureteral Reflux in Children: Polydimethylsiloxane (Macroplastique®) versus Dextranomer/Hyaluronic Acid Copolymer (Deflux®). Korean Journal of Urology, 51, 128-131.
[9] Gupta, A. and Snodgrass, W. (2008) Intra-Orifice versus Hydrodistention Implantation Technique in Dextranomer/ Hyaluronic Acid Injection for Vesicoureteral Reflux. The Journal of Urology, 180, 1589-1593.
[10] Kirsch, A.J., et al. (2004) The Modified Sting Procedure to Correct Vesicoureteral Reflux: Improved Results with Submucosal Implantation within the Intramural Ureter. The Journal of Urology, 171, 2413-2416.
[11] Puri, P., Chertin, B., Velayudham, M., Dass, L. and Colhoun, E. (2003) Treatment of Vesicoureteral Reflux by Endoscopic Injection of Dextranomer/Hyaluronic Acid Copolymer: Preliminary Results. The Journal of Urology, 170, 1541-1544.
[12] Routh, J.C. and Reinberg, Y. (2010) Predicting Success in the Endoscopic Management of Pediatric Vesicoureteral Reflux. Urology, 76, 195-198.
[13] Lavelle, M.T., Conlin, M.J. and Skoog, S.J. (2005) Subureteral Injection of Deflux for Correction of Reflux: Analysis of Factors Predicting Success. Urology, 65, 564-567.
[14] Yeung, C.K., Godley, M.L., Duffy, P.G. and Ransley, P.G. (1995) Natural Filling Cystometry in Infants and Children. British Journal of Urology, 31, 213.
[15] Yeung, C.K., Godley, M.L., Dhillon, H.K., Duffy, P.G., et al. (1998) Urodynamic Patterns in Infants with Normal Lower Urinary Tracts or Primary Vesico-Ureteric Reflux. British Journal of Urology, 81, 461-467.
[16] Ellsworth, P.I., Cendron, M. and McCullough, M.F. (2000) Surgical Management of Vesicoureteral Reflux. AORN Journal, 71, 496-513.
[17] Wolf Jr., J.S., Humphrey, P.A., Rayala, H.J., Gardner, S.M., Mackey, R.B. and Clayman, R.V. (1996) Comparative Ureteral Microanatomy. Journal of Endourology, 10, 527-531.
[18] Vahidi, B. and Fatouraee, N. (2012) A Biomechanical Simulation of Ureteral Flow during Peristalsis Using Intraluminal Morphometric Data. Journal of Theoretical Biology, 298, 42-50.
[19] Ellsworth, P.I., Yates, J.K. and Caldamone, A.A. (2011) Presence of Dextranomer-Hyaluronic Acid (DxHA) Mound on Postoperative Ultrasound Does Not Predict Resolution of Vesicoureteral Reflux. Journal of Pediatric Urology, 7, 438-440.
[20] Yucel, S., Gupta, A. and Snodgrass, W. (2007) Multivariate Analysis of Factors Predicting Success with Dextranomer/ Hyaluronic Acid Injection for Vesicoureteral Reflux. The Journal of Urology, 177, 1505-1509.
[21] Routh, J.C., Reinberg, Y., Ashley, R.A., Inman, B.A., Wolpert, J.J., Vandersteen, D.R., Husmann, D.A. and Kramer, S.A. (2007) Multivariate Comparison of the Efficacy of Intraureteral versus Subtrigonal Techniques of Dextranomer/Hyaluronic Acid Injection. The Journal of Urology, 178, 1702-1706.
[22] Sorensen, M., Koyle, M.A., Cowan, C.A., Zamilpa, I., Shnorhavorian, M. and Lendvay, T.S. (2010) Injection Volumes of Dextranomer/Hyaluronic Acid Are Increasing in the Endoscopic Management of Vesicoureteral Reflux. Pediatric Surgery International, 26, 509-513.
[23] Taheri Sadr, M., Karami, N. and Shirazi, M. (2012) A Novel Method for Measuring, Regardless of Image Distortion and Lens Varying Specifications in Endoscopic Treatment of Vesicoureteral Reflux. Journal of Biomedical Physics and Engineering, 2, 120-122.
[24] Lee, J.W., Lorenzo, E.I., Ahn, B., Oh, C.K., Kim, H.J., Han, W.K., Kim, J. and Rha, K.H. (2011) Palpation Device for the Identification of Kidney and Bladder Cancer: A Pilot Study. Yonsei Medical Journal, 52, 768-772.
[25] Dahms, S.E., Piechota, H.J., Dahiya, R., Lue, T.F. and Tanagho, E.A. (1998) Composition and Biomechanical Properties of the Bladder Acellular Matrix Graft: Comparative Analysis in Rat, Pig and Human. British Journal of Urology, 82, 411-419.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.