Endoscopic treatment of vesicoureteral reflux.
OBJECTIVE
The treatment of vesicoureteral reflux in children has seen a shift from invasive surgery to endoscopic management in recent years. Early studies demonstrate favorable outcomes but do not reach the success of surgery. Subspecialization also may play a role in the successful outcomes of all reflux management. This review focuses on the recent literature regarding endoscopic treatment of reflux and the role of subspecialization in treatment of children.


RESULTS
Dextranomer/hyaluronic acid copolymer has emerged as the favored bulking agent since its Food and Drug Administration approval in the United States. Although success is defined somewhat differently than surgery, overall success rates range from 82-89% with initial injection of dextranomer/hyaluronic acid. The outpatient nature of the procedure and its high success rate have led to a shift in treatment strategies especially in Europe, where endoscopic management is often considered first-line therapy. Extravesical reimplants can be performed on an outpatient basis safely. Subspecialization leads to improved outcomes with no difference in cost.


CONCLUSIONS
Endoscopic treatment of reflux is promising, but long-term results are not available to ascertain the efficacy of treatment into adulthood. Open surgery remains the gold standard.
Harrell
W Bruce
WB
University of Utah Health Sciences Center, Division of Urology, Primary Children's Medical Center, Salt Lake City, Utah 84113, USA.
Snow
Brent W
BW
D003911:Dextrans; D004724:Endoscopy; D006801:Humans; D006820:Hyaluronic Acid; D007267:Injections; D011138:Polytetrafluoroethylene / Q000008:administration & dosage; D019736:Prostheses and Implants; D016896:Treatment Outcome; D014718:Vesico-Ureteral Reflux / Q000503:physiopathology / Q000601:surgery*
D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D011138:Polytetrafluoroethylene; D006820:Hyaluronic Acid