[Endoscopic treatment of complicated vesicoureteral reflux grades III-V in infants under the age of one year].
OBJECTIVE
Our aim is to know the results of Endoscopic Treatment (ET) in infants with recurrent pyelonephritis and high grade (G) Vesicoureteral Reflux (VUR).


METHODS



METHODS
infants 2-12 months old with G III-V VUR and at least 2 pyelonephritis, one of them during antibiotic prophylaxis (AP). N = 27 infants: 19 males (70%) and 8 females. VUR was primary in 17 (63%) and secondary in 10. VUR Grade was III in 12 ureters (U) (32%), IV 16 (42%) and V 10 (26%). Polydimethylsiloxane, Hydroxiapatite and Dextranomer/ Hyaluronic Acid (DAH) were the bulking agents employed. Results Classification: Solved: G 0-I.; Improved: G II (control without AP); Persistence: III-V Open Surgery (OS) or repeated ET (1-2) was done depending on cystoscopic findings.


RESULTS
34 ureters are available for final results; 1 G III, 2 G IV and 1 G V are waiting for a new injection. G III 11 U: 11 first and 4 second injections (1.36 Injections / ureter): Solved 9 (81.8%), Improved 1, OS 1 (9%). G IV 14 U: 14 first 3 second and 1 third injection (1.28 injections / ureter): Solved 10 (71.4%), Improved 4. No OS. G V 9 U: 9 first, 4 second and 1 third injections (1.55 injections / ureter): Solved 5 (55.6%), Improved 1, OS 3 (33.3%). Overall results: Solved: 24 U (70.58%), Improved: 6 (17.6%), OS 4 (11.8%). OS avoided 30 (88.2%): G III 91%, IV 100% and V 66.7%. Results of G III are better than G V. The only complication was 1 ureteral obstruction treated successfully with open surgery.


CONCLUSIONS
ET can be considered the first therapeutic option in infants with G III-V VUR and pyelonephritis in spite of PA, because ET has solved VUR in 70.58% and avoided OS in 88.2% with a minimally invasive procedure and low incidence of complications.
Miguélez Lago
Carlos
C
Urología Pediátrica, Unidad de Cirugía Pediátrica del Hospital Materno Infantil, Complejo Hospitalario Universitario Carlos Haya de Málaga, España. miguelezlago@hotmail.com
Moreno Román
Jairo
J
García Mérida
Manuel
M
Galiano Duro
Eulogio
E
Mieles Cerchar
Moises
M
Ibáñez Cerrato
Fernando
F
D000465:Algorithms; D003558:Cystoscopy; D006801:Humans; D007223:Infant; D011446:Prospective Studies; D011704:Pyelonephritis / Q000209:etiology*; D012008:Recurrence; D018666:Ureteroscopy; D014552:Urinary Tract Infections / Q000209:etiology*; D014718:Vesico-Ureteral Reflux / Q000145:classification / Q000150:complications* / Q000628:therapy*