Long-term outcome of the endoscopic correction of vesico-ureteric reflux: a comparison of injected substances.
OBJECTIVE
To summarize the long-term outcome of endoscopic surgery to correct vesico-ureteric reflux (VUR) using different injected substances, i.e. autologous blood, hyaluronan/dextranomer copolymer (HDC), PTFE and glutaraldehyde cross-linked bovine dermal (GAX) collagen.


METHODS
Treatment results on 270 ureters of 185 patients followed for >5 years (mean 8.5) were summarized according to the injected substances. The substances were injected into the 6 o'clock position of the ureteric orifice endoscopically. "Success" was defined as the absence of VUR for >5 years after a single injection.


RESULTS
The treatment was successful in two of 24 patients (8%) with autologous blood, 17 of 32 (53%) with HDC, 108 of 171 (63%) with PTFE and 24 of 43 (56%) with GAX collagen. The success rate was lower in patients with higher grades of VUR.


CONCLUSIONS
Autologous blood is unsuitable for clinical application because of its poor durability. We will no longer use PTFE because its safety is not well established. The overall success rates of endoscopic surgery with GAX collagen and HDC were insufficient compared with surgical reimplantation, but it is advantageous that this procedure is less invasive and can be repeated. The cure rate could be improved by excluding high-grade VUR from the indications for endoscopic surgery.
Department of Urology, Kinki University School of Medicine, Osaka, Japan.
Takahide
T
Sugiyama
Tadashi
T
Hanai
Kiyushi
K
Hashimoto
Tohru
T
Umekawa
Takashi
T
Kurita
D000276:Adjuvants, Immunologic / Q000008:administration & dosage; D000293:Adolescent; D000328:Adult; D000368:Aged; D001804:Blood Transfusion, Autologous / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003094:Collagen / Q000008:administration & dosage / Q000031:analogs & derivatives*; D003432:Cross-Linking Reagents / Q000008:administration & dosage; D003558:Cystoscopy / Q000379:methods*; D003911:Dextrans / Q000008:administration & dosage; D005260:Female; D005976:Glutaral / Q000008:administration & dosage; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage; D007223:Infant; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene / Q000008:administration & dosage; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000379:methods*; D014718:Vesico-Ureteral Reflux / Q000601:surgery*
D000276:Adjuvants, Immunologic; D003432:Cross-Linking Reagents; D003911:Dextrans; C075314:GAX-collagen; C013471:dextranomer; D011138:Polytetrafluoroethylene; D006820:Hyaluronic Acid; D003094:Collagen; D005976:Glutaral