ENDOSCOPIC TREATMENT OF VESICOURETERAL REFLUX IN PATIENTS WITH MYELODYSPLASIA

Purpose: We assessed the usefulness of and indications for endoscopic treatment of vesicoureteral reflux in myelodysplasia patients. Materia ls and Methods: A total of 26 patients treated with intermittent cathe terization was divided into 11 (16 ureters) with and 15 without vesico ureteral reflux, In 9 patients (13 ureters) endoscopic correction was performed with 3% atelo-collagen and without anesthesia at the outpati ent clinic. In each ureter we obtained the sum of scores for 4 risk fa ctors for upper urinary tract deterioration: bladder compliance less t han 10 ml./cm, water, grade 2 to 3 bladder deformity, detrusor-sphinct er dyssynergia and urethral closure pressure 50 cm. water or greater. Results: No reflux was demonstrated immediately after the initial coll agen injection but cystography 3 to 6 months later showed recurrent re flux in 5 ureters (38%). Repeat injection cured the reflux, with resul ts persisting for an average of 17 months. Mean risk factor score for patients without vesicoureteral reflux was significantly lower than th at for patients with reflux. In patients treated with intermittent cat heterization and anticholinergic agents the mean score for ureters wit h an increased or unchanged reflux grade was significantly greater tha n for those with a decreased grade. Conclusions: Endoscopic treatment of reflux appears to be safe and useful in patients with myelodysplasi a, This treatment is preferable in those with high risk factor scores due to the possibility of increased reflux grade in such patients.