Vesicoureteral reflux.
The management options outlined earlier are based on the available treatment modalities; however, when a simple, successful, durable, minimally invasive method becomes available to treat vesicoureteral reflux, the approach likely will change. Endoscopic outpatient treatment of reflux has been available for about a decade. Treatment entails injection of a material into the submucosa at the refluxing ureteral orifice to bolster it, thus curing the problem. A suspension of microscopic size polytetrafluoroethylene (Teflon) particles has been used; however, its safety has been seriously questioned, as some evidence shows migration of the particles to other organ systems, including the central nervous system. More recently, cross-linked bovine collagen has been similarly used; however, it does not appear to be as durable. The use of other materials that are safe and will lead to long-term success are being studied. Chondrocytes and other nonbiologic materials, such as microspheres of bioglass and detachable balloons, are being evaluated. It is fairly certain that when a safe material is found, patients with mild to moderate reflux will be endoscopically treated upon recognition, thereby avoiding the use of long-term prophylaxis and periodic radiographic reevaluation.
Belman
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AB
Department of Pediatric Urology, Children's National Medical Center, Washington, DC, USA.
D002648:Child; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology; D011704:Pyelonephritis / Q000209:etiology; D016896:Treatment Outcome; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy