Endoscopic treatment of reflux: management pros and cons

Abstract

The management of vesicoureteral reflux has changed dramatically in the past decade, mostly because of the increasing acceptance of endoscopic injection therapy as an adequate, minimally invasive, and effective form of therapy. Recent advances in the composition of injectable materials have allowed for easier placement with a perceived favorable safety profile. In particular, dextranomer/hyaluronic acid has become the injectable material of choice, with quick acceptance and widespread use soon after its introduction in different countries. As we critically evaluate the evolving treatment options, the presented literature helps draw attention to some of the challenges we face and the need for long-term and carefully planned prospective studies to support our interventions.

Vesicoureteral reflux: From prophylaxis to surgery

“…The rate of contralateral low-grade VUR is reported at 4.5-7%. 35 Obstruction is one of the most common complications reported in the literature. It may manifest by renal colic, de novo hydroureteronephrosis, UTI, or lower urinary tract symptoms.…”

“…The rate of de novo contralateral reflux is 5-18% in open series. 35 This reflux is usually low-grade and may resolve spontaneously. Transient voiding dysfunction, as stated earlier, may also occur after surgery.…”

Endoscopic Treatment of Vesicoureteral Reflux Using Dextranomer/Hyaluronic Acid Copolymer in Children: Results of Postoperative Follow-Up with Real-Time 3D Sonography

“…The endoscopic approach is a minimally invasive surgical technique for treating VUR in children which has Pichler /Buttazzoni /Bektic /Schlenck / Radmayr /Rehder /Oswald gained widespread popularity due to its satisfying outcome [15] . In the clinical follow-up of patients treated endoscopically, VCUG is currently the first choice for the diagnosis of persistent VUR.…”

Medical versus surgical management for vesicoureteric reflux: the case for medical management

“…Seen from a different perspective, surgical correction alone carries the risk of disregarding important risk factors leading to problems down the road despite the initial radiological "success." 13,31,32 Addressing pelvic floor dynamics, fluid intake and elimination habits [33][34][35][36] can carry more weight (and potentially have a longer duration of benefit) than some of the surgical procedures we offer.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Nevertheless, the topic often departs from evidence-based medicine, moving towards more subjective (and difficult to challenge) arenas. 18 Unfortunately, the available level of evidence is rather modest, and we continue to practice based on limited data, which mostly address short-term and relatively meaningless outcomes.…”