[Clinical and radiological criteria for the therapeutic decision for vesicoureteral refux. Retrospective analysis of our experience].
OBJECTIVE
According to our experience, we present a proposal for the treatment of vesicoureteral reflux, based on both clinical and radiological evidences. We also describe how the introduction of endoscopic procedures has influenced the evolution of treatment indications as well as the time intervals for treatment.


METHODS
We have analysed all cases of vesicoureteral reflux treated in our Department in two periods of similar length: The first one (106 patients) comprised from 1995 to March 2001 (when endoscopic procedures were introduced). The second one (138 patients), comprised from March, 2001 to March 2007. Clinical, diagnostic, therapeutic and outcome-related variables were studied for all cases.


RESULTS
The number of patients was higher in the second period. In this period the number of cases requiring ureteral reimplantation decreased with respect to the first one (from 24 to 7). The success rate with endoscopic treatment reached 94.9%, with no significant differences regarding age or grade of reflux, although higher rates of failures were observed in children aged less than 3 years old and in high-grade reflux. The association of reflux with other malformations was not related with a worse evolution after treatment.


CONCLUSIONS
Endoscopic treatment, due to its similar efficacy and low aggressiveness, should be considered a valid alternative to open surgery (which offers good results but non-negligible comorbidity) for persistent reflux in which medical treatment has not been useful. We propose a tentative therapeutic scheme to establish the indications for each type of treatment depending on the grade of reflux and its clinical evolution.
Zuluaga Gómez
Armando
A
Servicio de Urología, Hospital Clínico Universitario San Cecilio, Granada, España. azuluagagomez@hotmail.com
Nogueras Ocaña
Mercedes
M
Díaz de la Guardia
Francisco Valle
FV
López León
Víctor
V
Jiménez Pacheco
Antonio
A
Ramírez Garrido
Francisco
F
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000628:therapy*