title: Failure of subureteral bovine collagen injection for the endoscopic treatment of primary vesicoureteral reflux in long-term follow-up.
abstract: OBJECTIVE
  To evaluate the long-term efficacy of subureteral glutaraldehyde cross-linked collagen injection (GAX 35) for endoscopic treatment of primary vesicoureteral reflux (VUR).
  
  
  METHODS
  We prospectively studied 36 patients (58 ureteral renal units), 30 girls and 6 boys with a median age of 6 years (range 2 months to 18 years). All patients had primary VUR and were treated with a single subureteral collagen injection (GAX 35). The patients were followed up by voiding cystography.
  
  
  RESULTS
  According to the International Reflux Study Classification, we found the following reflux grades preoperatively: grade I, 2 ureteral units; grade II, 21 units; grade III, 28 units; grade IV, 4 units, and grade V, 3 units. All patients were treated with subureteral bovine collagen injection (GAX 35, mean volume 1.7 mL, range 0.7 to 3.5). All but 3 cases of reflux resolved initially. The mean follow-up was 13 months (range 1 to 108). After 37 months of follow-up, only 5 (9%) of 57 treated units remained reflux free. One unit was followed up for 17 months and also remained reflux free.
  
  
  CONCLUSIONS
  These data suggest that a single endoscopic subureteral collagen injection is not effective in the long-term follow-up of patients with primary VUR. In the future, it will be important to determine whether the new, currently used, and soon be approved bulking agents show better long-term clinical results to prevent VUR recurrence than bovine collagen does.
authors.affiliation: Department of Urology, University of Heidelberg, Heidelberg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Haferkamp
authors.forename: H
authors.initials: H
authors.lastname: Contractor
authors.forename: K
authors.initials: K
authors.lastname: Möhring
authors.forename: G
authors.initials: G
authors.lastname: Staehler
authors.forename: J
authors.initials: J
authors.lastname: Dörsam
mesh_terms: D000293:Adolescent; D000818:Animals; D001672:Biocompatible Materials / Q000008:administration & dosage*; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D003094:Collagen / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D015552:Injections, Intralesional; D008297:Male; D011446:Prospective Studies; D013997:Time Factors; D017211:Treatment Failure; D018666:Ureteroscopy; D014718:Vesico-Ureteral Reflux / Q000628:therapy*
chemical_list: D001672:Biocompatible Materials; C048470:glutaraldehyde-cross-linked collagen; D003094:Collagen