Endoscopic treatment of vesicoureteral reflux: 11 to 17 years of followup.
OBJECTIVE
We review our 17-experience with endoscopic subureteral polytetrafluoroethylene injection for the treatment of primary vesicoureteral reflux in children.


METHODS
We retrospectively reviewed the charts of 258 patients with primary vesicoureteral reflux who were treated with subureteral polytetrafluoroethylene injection from 1984 to 1990.


RESULTS
The study included 205 girls and 53 boys between 3 months and 14 years old (median age 6 years). Of the patients 92 had unilateral vesicoureteral reflux, 129 had bilateral reflux and 37 had a refluxing duplex system including 6 with bilateral duplex systems. Endoscopic treatment by subureteral polytetrafluoroethylene injection was performed in 393 ureters. Reflux was corrected in 302 ureters (76.8%) after a single injection. Injection failed to stop reflux in 7 ureters (7 patients) and reimplantation was required. Patients were followed from 11 to 17 years with a mean followup plus or minus standard deviation of 13.5 +/- 3.4 years. Four patients were either lost to followup or parents refused to let them undergo voiding cystourethrography. Voiding cystourethrography in 247 patients with 379 ureters revealed that 360 ureters (95%) remain free of reflux whereas reflux recurred in 19 ureters (5%). Of these 19 ureters reflux was grade I or II in 13 for which no treatment was given and reflux was grade III or IV in 6, which required repeat injection. No untoward effects were seen in any of these patients with use of polytetrafluoroethylene as an injectable biomaterial.


CONCLUSIONS
Endoscopic subureteral polytetrafluoroethylene injection is a simple and effective outpatient procedure for in the treatment of vesicoureteral reflux. No long-term morbidity was observed in our patients with small amounts of injectable polytetrafluoroethylene.
Chertin
Boris
B
National Children's Hospital, Dublin and Children's Research Centre, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland.
Colhoun
Eric
E
Velayudham
Murugesh
M
Puri
Prem
P
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011138:Polytetrafluoroethylene / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D014718:Vesico-Ureteral Reflux / Q000601:surgery*
D011138:Polytetrafluoroethylene