[The treatment of vesicoureteral reflux].
OBJECTIVE
Vesicoureteral reflux (VUR) is a frequent pathology, with an incidence of 29/50% in children studied for urinary tract infection (UTI) and 20% of newborns with the diagnosis of prenatal hydronephrosis. Over the years, the treatment has been the subject of many meetings, many research studies, and continues being a topic under discussion. The number of candidates for surgical treatment increased with the development of minimally invasive endoscopic techniques by subureteral injection of bulking agents. We present the results of the surgical treatment of VUR between 2001 and 2006.


METHODS
We performed a retrospective study of the endoscopic treatment of VUR by subureteral injection of Dextranomer and hyaluronic acid copolymer (Copol-Dx/AH). All children undergoing treatment between July 1st 2001 and December 30th 2006 were included in this study. Treatment was performed in children with VUR grade II or greater. All patients presenting no reflux or grade I VUR on control VCUG were considered cured; stopping antibiotic prophylaxis was proposed in these cases.


RESULTS
661 children underwent treatment, 607 endoscopic and 54 with the Cohen technique. Among children treated endoscopically, 437 where females and 170 males. VUR was bilateral in 37.7% of the cases, with grade II being the most frequent (40% in males and 57% in females). Overall success rate was 70% after first treatment, 75% after second treatment and increased to 78% after the third.


CONCLUSIONS
Subureteral injection of dextranomer and hyaluronic acid copolymer is on effective treatment in children with VUR, independently of the grade. It is a simple, safe, well tolerated procedure with low associated morbidity. Currently, it is the surgical treatment of choice in most patients with VUR.
de Castro
Ribeiro
R
Servicio de Urología, Hospital María Pia, Porto, Portugal. luis.joao.castro@gmail.com
Massó
Pedro
P
Reis
Armando
A
D002648:Child; D002675:Child, Preschool; D003911:Dextrans / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage; D007223:Infant; D007267:Injections; D008297:Male; D012189:Retrospective Studies; D018666:Ureteroscopy; D014718:Vesico-Ureteral Reflux / Q000601:surgery / Q000628:therapy*
D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid