Endoscopic treatment of vesico-ureteral reflux: Twelve years' experience

Introduction: Over the past 12 years, endoscopic treatment of vesico-ureter al reflux (VUR) has gained in popularity and has proved successful in a hig h percentage of cases. With improvements in injectable materials and more e xperience with the technique, the indications for endoscopic treatment have broadened. In the present paper we report our experience on 679 patients a nd 953 refluxing ureters, treated over the past 12 years. Materials and Met hods: Reflux ranged from grade II to grade IV. In the first 14 cases Teflon was injected. After 1989, bovine dermal Collagen was used in 442 children and, more recently, the Deflux(R) system, a nonallergenic, biodegradable de xtranomer in sodium hyaluronan in 223 children. All patients were clinicall y investigated for voiding dysfunctions and all completed a 1-year followup . Results: After 1 or 2 injections the 1-year cystogram showed no VUR in 68 6 ureters (72%). In grade II, III and IV success rates were, respectively, 83, 69 and 41%. Complications were minimal (1%). Conclusions: Our results c onfirm endoscopic treatment of VUR is a valid alternative to long-term anti biotic prophylaxis and to open surgery in selected patients. The treatment often failed because of injected material displacement possibly due to void ing dysfunction. The short hospital stay, absence of significant postoperat ive complications, safety of the available injectable materials and high su ccess rate suggest that endoscopic treatment should be offered to all child ren with grade II and III VUR, whereas it is questionable in patients with grade IV VUR. In patients with voiding dysfunction, appropriate therapy and voiding rehabilitation should precede treatment of VUR. Copyright (C) 2001 S. Karger AG, Basel.