Long-term efficacy of subureteral collagen injection for endoscopic treatment of vesicoureteral reflux in neurogenic bladder cases

Purpose: We evaluated the long-term efficacy of subureteral glutaraldehyde cross-linked collagen injection (GAX 35*) for endoscopic treatment of vesic oureteral reflux in patients with neurogenic bladder dysfunction due to men ingomyelocele. Materials and Methods: We prospectively studied 12 women and 8 men (26 ureteral renal units) with a median age of 8 years (range 1 to 5 1) who had neurogenic bladder due to meningomyelocele. Reflux into single c ollecting systems was treated with subureteral collagen injection (GAX 35). Followup with video urodynamics included voiding cystography. Results: All patients performed intermittent catheterization to control the bladder. Du ring the study all bladders were areflexic with normal compliance. Preopera tive reflux according to the International Reflux Study Classification was grade I in 1, II in 9, III in 10, IV in 4 and V in 2 ureteral renal units. All patients were treated with subureteral collagen injection (mean volume 1.9 ml., range 0.7 to 3.5). Reflux resolved initially in all but 2 cases. M ean followup was 16 months (range 1 to 71). Reflux was still absent in only 15% of treated units after 24 months. Conclusions: Our data suggest that e ndoscopic subureteral collagen injection in neurogenic bladder cases is not effective with long-term followup, New biocompatible and biodegradable mat erials should be tested to control vesicoureteral reflux.