Pitfalls of repeat subureteral bovine collagen injections for the endoscopic treatment of vesicoureteral reflux.
OBJECTIVE
Collagen has been used for the endoscopic subureteral treatment of vesicoureteral reflux since the late 1980s. We evaluated the long-term efficacy of repeat subureteral glutaraldehyde bovine cross-linked collagen injections for the endoscopic management of vesicoureteral reflux.


METHODS
We prospectively evaluated 14 girls and 2 boys (21 ureteral units) 6 months to 16 years old (median age 6 years). In all patients initial treatment failed or reflux recurred after a single subureteral collagen injection and injection was repeated. Patients were followed with voiding cystography. Reflux-free periods after each injection and reflux grade were documented.


RESULTS
All patients were treated twice with subureteral bovine collagen injection. Mean injected collagen volume of injections 1 and 2 was 1. 5 ml. (range 0.7 to 3.0) and 1.6 ml. (range 1.0 to 2.3), respectively, at a concentration of 35 mg./ml. In all but 4 cases reflux disappeared after injection 2. Mean followup was 11 months (range 1 to 41) after treatment 2. However in 10 patients (13 ureteral units) treatment failed or reflux recurred a mean of 10 months after injection 2. The reflux-free period after injection 2 was prolonged compared to that after injection 1 (p <0.05).


CONCLUSIONS
Our results suggest that repeat endoscopic subureteral bovine collagen injections prolong the reflux-free period but remain ineffective at long-term followup for correcting vesicoureteral reflux.
Haferkamp
A
A
Department of Urology, University of Heidelberg, Heidelberg, Germany.
Möhring
K
K
Staehler
G
G
Dörsam
J
J
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003094:Collagen / Q000627:therapeutic use*; D004724:Endoscopy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D019233:Retreatment; D017211:Treatment Failure; D014718:Vesico-Ureteral Reflux / Q000628:therapy*
D003094:Collagen