[Endoscopic treatment of vesicoureteral reflux (VUR). Comparison of various substances. Long-term results].
OBJECTIVE
The VUR is one of the most frequent pathologies in pediatric urology. Classically it has been managed with medical or surgical treatment depending on age, grade, and other variables. Over the last years, urologists have started to perform endoscopic treatment with various substances, surgery but minimally invasive. The objective of this work is to evaluate our results with this method.


METHODS
Between 1996 and 2004 we performed endoscopic treatment on 41 patients (70 ureters) using different substances. We analyze VUR grade and side, improvement with one or more injections, post-operative follow-up with clinical evaluation, bladder ultrasound and voiding cystourethrogram (VCUG), and compare the long-term results of the different substances used, mainly with the evaluation of recurrences and/or urinary tract infections.


RESULTS
41 patients entered the study; collagen was injected in 13 cases, Macroplastique in 14, and Deflux in 14. Twenty-nine patients underwent bilateral injection, adding up to a total of 70 injected ureters. Collagen injection had a success rate of 53% with the first injection and 77% with the second, Macroplastique success rate was 83% with the first injection and 91% with the second, and Deflux 84% on first injection and 88% with the second. Mean post-operative follow-up was 44 months, with a range of 18-86 months. 18% of the patients presented post operative UTI, they were treatment failures. There are no UTI episodes in patients after successful treatment.


CONCLUSIONS
Endoscopic treatment is a useful tool in the long-term management of VUR, both as definitive treatment or as on alternative to conventional medical management, with better results when using Macroplastique and Deflux.
Escala Aguirre
José Manuel
JM
Servicio de Urología, Hospital Exequiel González Cortes, Santiago, Chile. jmescala@clinicalascondes.cl
Cadena González
Yair
Y
Retamal Pinto
Gabriela
G
López Egaña
Pedro-José
PJ
Letelier Cancino
Nelly
N
Zubieta Acuña
Ricardo
R
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003094:Collagen; D003558:Cystoscopy; D003911:Dextrans; D004129:Dimethylpolysiloxanes; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid; D007223:Infant; D008297:Male; D013997:Time Factors; D018666:Ureteroscopy; D014718:Vesico-Ureteral Reflux / Q000628:therapy*
D003911:Dextrans; D004129:Dimethylpolysiloxanes; C094535:deflux; C013830:baysilon; D006820:Hyaluronic Acid; D003094:Collagen