The role of endoscopic treatment of vesicoureteral reflux: a 17-year experience.
OBJECTIVE
During the last 20 years endoscopic treatment of vesicoureteral reflux (VUR) has gained popularity in European countries. We performed a retrospective analysis of our 17-year experience with more than 1,000 patients treated to assess whether technique, indications or results of endoscopic treatment of VUR have changed over time.


METHODS
From January 1986 to June 2002, 1,244 patients underwent endoscopic treatment for grades II to IV VUR. Polytetrafluoroethylene was injected as the bulking material in the first 14 cases, after 1989 bovine cross-linked collagen was used in 442 and since 1995 dextranomer/hyaluronic acid copolymer was used in 788. Urinary tract ultrasound was performed 1 and 6 months, and micturition cystourethrogram was done 3 and 12 months after endoscopic treatment. All patients included in the study completed a minimum 12-month followup.


RESULTS
Endoscopic treatment was always performed in 1 day. Complications were observed in 0.5% of cases. After 1 or 2 injections the micturition cystourethrogram showed no significant VUR (absent or grade I) in 77% of cases. The success rate was 88%, 75% and 52% for grades II, III and IV VUR, respectively. With increasing experience not only primary VUR, but also secondary reflux was considered eligible for endoscopic treatment, and the number of grade IV VUR cases treated by endoscopy also increased. The presence of voiding dysfunction was identified as a limiting factor in the success of endoscopic treatment.


CONCLUSIONS
The short hospital stay, acceptable success rate and absence of significant complications prompt us to consider endoscopic treatment as first choice treatment of VUR rather than long-term prophylaxis and open surgery. Even grade IV VUR and VUR in complex anatomical situations can be successfully treated by endoscopy. Patients with voiding dysfunction should be identified and adequately treated before any endoscopic attempt.
Capozza
Nicola
N
Department of Pediatric Urology, Bambino Gesù Children's Hospital, Rome, Italy. capozza@opbg.net
Lais
Alberto
A
Nappo
Simona
S
Caione
Paolo
P
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003558:Cystoscopy; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D012189:Retrospective Studies; D013997:Time Factors; D018666:Ureteroscopy; D014718:Vesico-Ureteral Reflux / Q000628:therapy*