Efficiency of endoscopic treatment compared to open surgical management of the vesicoureteral reflux

Abstract

Introduction: Vesicoureteral reflux (VUR) represents the retrograde flow of urine from the bladder to the upper urinary tract. It can be managed by continuous antibiotic prophylaxis of the urinary tract infections until spontaneous resolution occurs, surgical ureteral reimplantation (ureteroneocystostomy), or endoscopic treatment by injecting bulking agents. The aim: To assess the efficacy of the endoscopic treatment of VUR in comparison to the ureteroneocystostomy. Material and methods: The first group included 300 children with VUR, II to IV grades managed by endoscopic injection from 2005 to 2015, and second group included 300 patients who underwent surgical treatment for the IV or V grade of VUR from 1997 until 2009. The results of treatment and complication rate were analysed and compared. We did the same analysis considering the total number of ureteral units. Results: Of total of 300 patients treated endoscopically, in 281 (93.67%) patients the reflux was completely resolved; in 10 (3.33%), the reflux was downgraded (decreased for one or two grades) and in 9 (3%) the intervention was unsuccessful. In 430 ureteral units, full resolution was achieved in 402 (93.49%) units; in 10 (2.33%), the reflux was downgraded and in 18 (4.65%) the reflux didn't resolve. In 300 patients who underwent open surgery, in 290 (96.7%) the reflux was resolved; in 8 (2.67%), the reflux was downgraded from the V/IV to the grades I to III; in 2 (0.66%) the operation was unsuccessful. Out of 480 ureteral units, in 463 (96.46%) units the reflux was resolved; in 13 (2.71%), the grade of reflux was reduced, while in 4 (0.83%) units the reflux was persistent. Recorded success rate didn't show any statistically significant difference between these two groups. The length of hospital stay was significantly shorter and the number of complications was lower in the group of patients treated by endoscopic injection. Conclusion: Comparable success rate, shorter hospital stay, and fewer complications make the endoscopic treatment more preferable option.