[Success of endoscopic management in vesicoureteral reflux, conditioned by ureteral dilatation].
BACKGROUND
Endoscopic management has become an important alternative in the treatment of vesicoureteral reflux in children. Since 1995 we indicate it in our Hospital in children with grade II VUR (vesicoureteral reflux) after 1 year of medical management, in all children with grade III VUR and in children with grade IV VUR without reflux nephropathy. According to International Classification of reflux (IRSC), grade IV VUR differ to grade III mainly by the blunting of the calyces and the obliteration of sharp angle of the fornices. There may be seen in the high grades of reflux, important differences in the ureteral dilatation.


OBJECTIVE
The aim of this work is to study the influence of ureteral dilatation in the success of endoscopic management VUR.


METHODS
A number of 245 refluxing renal units (URR) were treated endoscopically in our Hospital from 1995. We review the first 3.5 years (58 patients with 90 RRU). In a double blind study with the voiding cystourethrographies we graduated the ureteral dilatation in slight-normal, moderate and severe. The success rate after the first injection was compared between the 3 grades of ureteral dilatation.


RESULTS
3 patients had grade I VUR, 10 grade II, 54 grade III and 23 grade IV. After double blind study 39 patients had slight-normal ureteral dilatation, 39 moderate and 12 severe. There were statistical differences between the 3 grades of ureteral dilatation when we consider: all the patients, considering only grade III and IV reflux and studying only the patients with grade III reflux. However there wasn't statistical differences between grade III and IV VUR of the International Classification.


CONCLUSIONS
The results show that ureteral dilatation is an important prognostical factor of the success rate in the endoscopic management of vesicoureteral reflux in children.
D002648:Child; D002675:Child, Preschool; D004106:Dilatation; D006801:Humans; D007223:Infant; D014513:Ureter; D018666:Ureteroscopy; D014718:Vesico-Ureteral Reflux / Q000601:surgery*
La dilatación ureteral condiciona el éxito del tratamiento endoscópico del R.V.U.