title: The effect of location of the ureteric orifice on the efficacy of endoscopic injection to correct vesico-ureteric reflux.
abstract: OBJECTIVE
  To review our 11-year experience and identify the mechanisms responsible for the failure of endoscopic injection for vesico-ureteric reflux (VUR) with three different injectable agents, based on the location of the ureteric orifice on endoscopy.
  
  
  METHODS
  We retrospectively reviewed the charts and endoscopic video-photographs of 46 patients (26 girls, 20 boys, median age 6 years, range 2-16) with VUR treated once or twice by subureteric injection with PTFE, or polydimethylsiloxane or dextranomer/hyaluronic acid copolymer, from 1992 to 2003. Five patients were lost to follow-up and six ectopic and/or duplicated ureters were excluded from the analysis; in all, 52 ureters were analysed. According to the international classification, the VUR was grades I to V in four (8%), 12 (23%), 16 (31%), 13 (25%) and seven (13%) ureters, respectively.
  
  
  RESULTS
  After 3 months, voiding cysto-urethrography showed that VUR continued in six of 19, seven of 12 and eight of 21 ureters (38%), respectively, after subureteric PTFE, polydimethylsiloxane and dextranomer/hyaluronic acid copolymer injection; after the second injection, reflux continued in two of six, four of seven and three of eight ureters, respectively. Mound displacement and/or volume loss was the most common failure with all three bulking agents after both the first (62%) and second injections (44%) (P < 0.05). The first injection failed in 32% (11 of 35) normally located ureters and 10 of 17 lateral ureters (P < 0.05). The second injection failed in 11% (four of 35) normal and five of 17 lateral ureters (P < 0.05).
  
  
  CONCLUSIONS
  A lateral ureteric orifice may decrease the efficacy of endoscopic injection, as the likelihood of a faulty injection is greater. However, a more careful second injection decreases the failure rate, particularly in those with low- to medium-grade refluxing ureters.
authors.affiliation: Department of Urology and Paediatric Surgery, Akdeniz University School of Medicine, Antalya, Turkey. syucel@akdeniz.edu.tr
authors.forename: Selcuk
authors.initials: S
authors.lastname: Yucel
authors.forename: Murat
authors.initials: M
authors.lastname: Ucar
authors.forename: Erol
authors.initials: E
authors.lastname: Guntekin
authors.forename: Erdal
authors.initials: E
authors.lastname: Kukul
authors.forename: Mustafa
authors.initials: M
authors.lastname: Melikoglu
authors.forename: Mehmet
authors.initials: M
authors.lastname: Baykara
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D011138:Polytetrafluoroethylene / Q000008:administration & dosage*; D012189:Retrospective Studies; D014513:Ureter / Q000002:abnormalities*; D018666:Ureteroscopy; D014718:Vesico-Ureteral Reflux / Q000473:pathology / Q000628:therapy*
chemical_list: D011138:Polytetrafluoroethylene