Endoscopic Treatment of Vesico-Ureteral Reflux: Twelve Years’ Experience

Abstract

Introduction: Over the past 12 years, endoscopic treatment of vesico-ureteral reflux (VUR) has gained in popularity and has proved successful in a high percentage of cases. With improvements in injectable materials and more experience with the technique, the indications for endoscopic treatment have broadened. In the present paper we report our experience on 679 patients and 953 refluxing ureters, treated over the past 12 years. Materials and Methods: 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^® system, a nonallergenic, biodegradable dextranomer in sodium hyaluronan in 223 children. All patients were clinically investigated for voiding dysfunctions and all completed a 1-year follow-up. Results: After 1 or 2 injections the 1-year cystogram showed no VUR in 686 ureters (72%). In grade II, III and IV success rates were, respectively, 83, 69 and 41%. Complications were minimal (1%). Conclusions: Our results confirm endoscopic treatment of VUR is a valid alternative to long-term antibiotic prophylaxis and to open surgery in selected patients. The treatment often failed because of injected material displacement possibly due to voiding dysfunction. The short hospital stay, absence of significant postoperative complications, safety of the available injectable materials and high success rate suggest that endoscopic treatment should be offered to all children 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.

Endoscopic treatment of vesicoureteral reflux in children with subureteral dextranomer/hyaluronic acid injection: a single-centre, 7-year experience

“…A similar result was reported by Kirch an colleagues 10,27 and Capozza and Caione. 28 Results of endoscopic treatment in grade 4 and 5 VUR are substantially weaker than in grades 1-3; As such, some authors are hesitant about the feasibility of endoscopic treatments for higher-grade VUR. 29 We do not agree with that attitude.…”

“…28 Results of endoscopic treatment in grade 4 and 5 VUR are substantially weaker than in grades 1-3; As such, some authors are hesitant about the feasibility of endoscopic treatments for higher-grade VUR. 29 We do not agree with that attitude. In our series involving patients with primary VUR, there were 25 ureters with grade-5 VUR, and 88% of them were cured with 1, 2 or 3 injections.…”

The effect of microsphere degradation rate on the efficacy of polymeric microspheres as bulking agents: An 18‐month follow‐up study

“…[1][2][3] In these treatments, an injectable bulking agent is injected into the ureteral orifice or bladder neck using arthroscopy to induce anatomical changes. These endoscopic procedures are attractive because they are minimally invasive and it is anticipated that they will decrease patient discomfort, surgery extent, and operating time.…”

“…These endoscopic procedures are attractive because they are minimally invasive and it is anticipated that they will decrease patient discomfort, surgery extent, and operating time. [1][2][3][4][5][6] Several injectable bulking agents, such as polytetrafluoroethylene (PTFE) paste, 7,8 collagen gel, 9 -12 liquid or particulated silicone, [13][14][15][16] polymethylmethacrylate (PMMA) microspheres, [17][18][19] and autologous fat, 20,21 have been developed and applied in the injection therapies. However, concerns regarding the side effects of these materials have limited general acceptance of their usage.…”

Pri̇mer Vezi̇koüreteral Reflünün Tedavi̇si̇nde Endoskopi̇k Subüreteral Kollajen Enjeksi̇yonunun Uzun Dönem Etki̇nli̇ği̇

“…Ürolojide VUR'un tedavisinde hacimleştirici diğer bir ajan olan kollajenin kullanımı 1980'lerin sonunda yaygınlaşmıştır. Bu tarihten itibaren, literatürde VUR tedavisinde kollajenin etkinliği konusunda birçok karşıt yayın-lar mevcuttur (3,(5)(6)(7). Tedavi sonrası en büyük problem reflünün rekürrensine sebep olan implantın volüm kaybıdır (6-9).…”