[The efficacy of endoscopic treatment for secondary vesicoureteral reflux. Analysis of a series of 142 cases].
OBJECTIVE
To evaluate the rate of secondary or complicated vesicoureteral reflux (VUR) among the total number of VUR cases treated in our institution. To determine the efficacy of the endoscopic treatment in secondary or complicated VUR depending on etiology and grade.


METHODS
We review our experience with endoscopic treatment for VUR from 1992 to 2006. We have used three different materials: polytetrafluoroethylen (Teflon), polydimethyls iloxane (Macroplastique) and dextranomer/hyaluronic acid copolymer (Deflux). 479 ureters with VUR were treated in 402 patients; 124 patients and 142 ureters of them were secondary or complicated VUR cases. All patients were followed up with urinary tract ultrasound and radiological or isotopic voiding cystogram. Success is defined as VUR disappearance or improvement to grade I VUR without urinary infection after removing antibiotic prophylaxis.


RESULTS
The success rate has been 71.13% after the first injection, 85.92% after the second injection and 90.14% after the third injection. Mean subureteral dose has been 0.65 ml. The complications rate has been 0%.


CONCLUSIONS
The endoscopic treatment in secondary or complicated VUR is a minimally invasive procedure. It seems to be more difficult than in primary VUR cases, but its low morbidity and efficacy indicate this may be a proper first option in selected patients. In cases of VUR secondary to neurogenic bladder dysfunction it seems to be less successful, probably because of a worse control of the high bladder pressure.
Fernández Hurtado
Miguel Angel
MA
Sección de Urología Pediátrica, Servicio de Cirugía Pediátrica, Hospitales Universitarios Virgen del Rocío, Sevilla, España. drmafh@hotmail.com
Barrero Candau
Rafael
R
Argüelles Salido
Enrique
E
Fernández Pineda
Israel
I
García Merino
Francisco
F
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003911:Dextrans; D004129:Dimethylpolysiloxanes; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid; D007223:Infant; D008297:Male; D011138:Polytetrafluoroethylene; D001750:Urinary Bladder, Neurogenic / Q000150:complications; D014718:Vesico-Ureteral Reflux / Q000209:etiology / Q000628:therapy*
D003911:Dextrans; D004129:Dimethylpolysiloxanes; C094535:deflux; C013830:baysilon; D011138:Polytetrafluoroethylene; D006820:Hyaluronic Acid