The effect of location of the ureteric orifice on the efficacy of endoscopic injection to correct vesico‐ureteric reflux

Abstract

excluded from the analysis; in all, 52 ureters were analysed. According to the international classification, the VUR was grades I to V in four (8%), 12 (23%), 16 (31%), 13 (25%) and seven (13%) ureters, respectively. RESULTSAfter 3 months, voiding cysto-urethrography showed that VUR continued in six of 19, seven of 12 and eight of 21 ureters (38%), respectively, after subureteric PTFE, polydimethylsiloxane and dextranomer/ hyaluronic acid copolymer injection; after the second injection, reflux continued in two of six, four of seven and three of eight ureters, respectively. Mound displacement and/or volume loss was the most common failure with all three bulking agents after both the first (62%) and second injections (44%) ( P < 0.05). The first injection failed in 32% (11 of 35) normally located ureters and 10 of 17 lateral ureters ( P < 0.05). The second injection failed in 11% (four of 35) normal and five of 17 lateral ureters ( P < 0.05). CONCLUSIONSA lateral ureteric orifice may decrease the efficacy of endoscopic injection, as the likelihood of a faulty injection is greater. However, a more careful second injection decreases the failure rate, particularly in those with low-to medium-grade refluxing ureters.

Endoscopic Treatment of Vesicoureteral Reflux with Polydimethylsiloxane in Adults: Do Location and Appearance of the Ureteric Orifice Have a Role in the Success Rates?

“…In previous studies of adults with reflux, the amount of material injected ranged from 1.0 to 4.0 ml, which is somewhat more than in children [8,10,13,17] . In our experience, subureteral injection was technically difficult in adults, and the CAU were common (30.18%).…”

“…Most failures are generally due to technical errors or displacement of the implant in CAU with a short submucosal tunnel [14][15][16] . In a recent study, of 52 ureters, the second injection failed in 4 of 35 normally located ureters (88.57%) and 5 of 17 lateral ureters (70.59%) [17] . In our study, unsuccessful cases often had such large orifices that we were even able to go through the orifice using a 17-french cystoscope.…”

Endoscopic treatment of vesicoureteral reflux using calcium hydroxyl apatite in dogs

“…Research is concentrated on elucidating the quantity of the biomaterial, the site of injection, local reaction and potential migration to distant organs. Many natural materials have been tested experimentally with advantages and disadvantages [3,11-13]. The objective of this study was to investigate the effect of the newly introduced biomaterial, calcium hydroxyl apatite (an Iranian made product), on treating experimentally induced vesicoureteral reflux, using minimally invasive procedure, in dogs.…”

Long-Term Results of Dexell Endoscopic Treatment of Vesicoureteral Reflux: An Option for the Management of Recurrent Urinary Tract Infection

“…Factors associated with a lower success rate were neuropathic bladder (32,33) and mound morphology (38). Also, site of the ureteric orifice showed to be important as lateral ureteric orifice decreased the efficacy of endoscopic injection (39). In addition, associated complex VUR caused lower success rate (40).…”