Endoscopic treatment of children with vesico-ureteric reflux

Endoscopic subureteric injection of tissue-augmenting substances hat; becom e an alternative to long-term antibiotic prophylaxis and open surgery in th e treatment of children with vesico-ureteric reflux. Successful elimination of reflux in about 80% of patients after a single injection (and in 90% af ter a repeat) has been achieved using the foreign-body non-degradable subst ances Teflon and silicone. Few patients have required open surgery and recu rrence of reflux after initial successful treatment has occurred in only 5- 10%. Concern has arisen, however, about Possible distant migration and gran uloma formation after injection of particulate plastic materials. Crosslink ed bovine collagen is a biodegradable alternative substance, but with a low er response rate of 60% after the first treatment and a recurrence rate of 10-20%. Dextranomer in sodium hyaluronan is a new biological substance with microparticles with a response rate of 69% after the first injection. Biol ogical substances have caused few complications. Present literature on inje ction treatment unfortunately focuses on elimination of reflux, with little attention to subsequent frequency of pyelonephritis or to the long-term de velopment of the kidneys. Furthermore, there are no controlled, randomized studies with subureteric injection as one of the treatment alternatives. Th us, although having the advantage of being a minimally invasive procedure t hat can be performed on an outpatient basis, this technique needs to be tes ted in a large prospective study with the long-term renal outcome as the ma in end-point.