Endoscopic treatment of vesicoureteral reflux in the previously reimplanted ureter: technical aspects and results.
OBJECTIVE
To assess the feasibility and results of the endoscopic treatment of vesicoureteral reflux (VUR) after a failed ureteral reimplantation.


METHODS
From January 1996 to October 2006, 28 patients underwent endoscopic treatment for VUR grade II to V persisting after open ureteral reimplantation. VUR was bilateral in 11 patients, for a total of 39 ureteral units (UU) treated. The endoscopic treatment was performed 1 to 7 years after surgery (average 2.5 years). Dextranomer/Hyaluronic acid Copolymer (Dx/HA) was used as injectable material. The amount of injected material ranged from 0.5 to 2.8 ml (average: 1.2 ml). Some technical refinements were required to increase the success of the procedures. Patients were followed up from 2.5 to 17 years. Voiding cystourethrogram (VCUG) was performed at 6 months and MAG3 renal scan with voiding phase at 24 months. Results were compared with the outcome of the endoscopic treatment in patients treated by the same surgeons for primary VUR, matched for grade (control group).


RESULTS
All treatments were performed as one-day procedure. No complications were observed. Success was achieved in 22/28 patients (78.5%) and in 30/39 UU (76.9%) after failed ureteral reimplantation. No significant difference in success rate was found from the control group (p = ns).


CONCLUSIONS
Endoscopic treatment of VUR after a failed reimplantation can be a challenging procedure, for a skilled endoscopists. Nonetheless it can achieve successful results in a high percentage of patients with minimal morbidity and a minimal invasiveness; it should thus be recommended for these patients.
Capozza
Nicola
N
Department of Pediatric Urology, Bambino Gesù, Children's Hospital, Rome, Italy. capozza@opbg.net
Nappo
Simona
S
Caione
Paolo
P
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003911:Dextrans; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid; D007267:Injections; D008297:Male; D014513:Ureter / Q000601:surgery; D014718:Vesico-Ureteral Reflux / Q000601:surgery / Q000628:therapy*
D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid