The role of endoscopic treatment in the management of grade v primary vesicoureteral reflux.
OBJECTIVE
Although endoscopic treatment provides a high rate of success in children with grades II-IV vesicoureteral reflux (VUR), its role in the management of grade V reflux has been questioned. In this study we reviewed our 21-yr experience of endoscopic treatment in children with grade V primary VUR.


METHODS
We retrospectively reviewed the medical records of 132 children who underwent endoscopic treatment for primary grade V reflux from 1984 to 2004. VUR was unilateral in 39 patients and bilateral in 34, and 59 patients had ipsilateral grade V reflux with a lower grade of VUR on the contralateral side. Endoscopic treatment was performed in a total of 166 grade V ureters; polytetrafluoroethylene was used from 1984 to 2000 and dextranomer/hyaluronic acid from 2001 to 2004. Median follow-up was 12.2 yr and mean follow-up was 13.4 yr.


RESULTS
VUR was completely resolved after first injection in 88 (53%) ureters and downgraded to grade I or II in 26 (15.7%). VUR resolved after a second and third injection in 36 (21.7%) and 10 (6%) of ureters, respectively. Endoscopic treatment failed to correct VUR in 6 (3.6%) ureters, requiring ureteral reimplantation in 5 and nephrectomy in 1. Thirteen patients developed urinary tract infections during the follow-up period, and on investigation 9 ureters (5.4%) had recurrence of VUR. No injection or morbidity related to tissue-augmenting substances was noted in any patient.


CONCLUSIONS
Endoscopic treatment should be the first-line of treatment in management of grade V vesicoureteral reflux.
Menezes
Maria N
MN
The National Children's Hospital, Dublin, Ireland.
Puri
Prem
P
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003558:Cystoscopy / Q000379:methods*; D003911:Dextrans / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage; D007223:Infant; D007267:Injections; D008297:Male; D011138:Polytetrafluoroethylene / Q000008:administration & dosage; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder; D014563:Urodynamics; D014567:Urography; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*
D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D011138:Polytetrafluoroethylene; D006820:Hyaluronic Acid