ENDOSCOPIC SUBURETERAL COLLAGEN INJECTION FOR THE TREATMENT OF VESICOURETERAL REFLUX IN INFANTS AND CHILDREN

Between June 1988 and September 1994, 100 girls and 32 boys 2 months t o 15.5 years old (average 4.9 years) with 204 refluxing ureteral units were treated by endoscopic subureteral collagen injection. The collag en injected was of bovine origin and cross-linked with glutaraldehyde (Zyplast). Followup ranged from 3 to 75 months (mean 33). Reflux was a bsent in 62.7% of cases 3 months after 1 endoscopic subureteral inject ion. Improvement to reflux grades I and II, generally not requiring fu rther treatment, occurred in a further 15.2% of cases. A total of 66 u reters was injected twice, The overall cure rate after 1 or 2 injectio ns was 79.4% 3 months after injection. There was no correlation betwee n the risk of recurrent reflux and initial degree of reflux. Late recu rrence of reflux following a reflux-free period occurred in 11.3% of t he 204 units during the observation period, which varied from 3 months to 61/4 years. Reflux was absent after 1 or 2 injections, including l ate recurrence, in 70.6% of cases and in an additional 13.2% recurrent reflux was grade I or II, not necessitating any further treatment. Co nsidering these results, subureteral collagen injection remains an ade quate method of treatment for vesicoureteral reflux in children.