Possible causes of unsuccessful endoscopic collagen treatment of vesicoureteric reflux in children

Objective: The purpose of this prospective study was to identify possible c auses of unsuccessful treatment of vesicoureteric reflux (VUR) in children by endoscopic collagen injection. Patients and Methods: Between February 19 94 and September 1996, 130 primary VURs in 94 children aged 3-16 years were treated by endoscopic injection of collagen. Grade 2 VUR was found in 46 u reteric units, grade 3 in 55, and grade 4 in 11 ureteric units. Seventy-sev en children had normal micturition, and 17 showed signs of an unstable blad der. The collagen injection was performed under general anasthesia. All chi ldren had a follow-up assessment on average 5.1 months after the first inje ction of collagen. They were evaluated by micturition cystography and ultra sound examination of the urinary tract. Results: A single injection of coll agen eliminated VUR in 74 (56.9%) cases. There was a statistically signific ant correlation between the grade of VUR and the success rate of collagen t herapy (p < 0.01). The average amount of collagen used in cured and in nonc ured children was 0.55 and 0.76 ml, respectively (p < 0.01). Children with normal appearance of the ureteric orifice had significantly better results as compared with other children (p < 0.01). There was no statistically sign ificant correlation between the success rate of treatment and the place of collagen injection or the shape of ureteric orifice following the injection . A statistically significant association, however, was found between the f unction of the lower urinary tract and the results of endoscopic collagen t reatment for VUR (p < 0.05). Ultrasound showed no obstruction of the upper urinary tract. Conclusion: High-grade VUR, incorrect technique of injection , and voiding dysfunction seem to be some of the possible causes of an unsu ccessful endoscopic collagen treatment of VU R in children. Copyright (C) 1 999 S. Karger AG, Basel.