[Endoscopic treatment of vesicoureteral reflux in pediatric patients with the diagnosis of neurogenic bladder. Results and long-term outcome].
OBJECTIVE
To know the results, complications and outcomes of eight patients with the diagnosis of neurogenic bladder (NB) who underwent vesicoureteral reflux surgery by subureteral injection of inert substances, trying to precise its indication in the therapeutic scheme for neurogenic bladder dysfunction.


METHODS
Retrospective review of the results and complications recorded during follow-up in eight pediatric patients with NB secondary to various pathologies and the diagnosis of VUR treated by subureteral injection of Teflon paste (1 case), polydimethylsiloxane (6) and dextranomer/hyaluronic acid copolymer (1).


RESULTS
In 8 (72.7%) of the 11 ureters treated VUR was cured after first injection. VUR stopped after second endoscopic treatment in 2 of the 3 ureters with persistent VUR. The efficacy of endoscopic treatment after second injection achieved 90.9%. In 2 unilateral cases we observed contralateral VUR, which cured in one case after endoscopic treatment and the other one followed a conservative scheme. Over the follow-up period (Mean FU time 51.8 +/- 28.5 months) 4 cases presented complications. VUR recurred in two: in one contralateral VUR was detected 19 months after first treatment, the other one presented bilateral ureterohydronephrosis with recurrent urinary tract infections and required augmentation cystoplasty.


CONCLUSIONS
Endoscopic treatment is an effective option when choosing surgical treatment for VUR in a patient with neurogenic bladder. It is necessary to follow the long-term outcome of patients after surgery, mainly those with abnormal bladder capacity and compliance and active or dyssynergic urethra due to the possibility of recurrence of the VUR.
Estornell Moragues
Francisco
F
Servicio de Urología Pediátrica, Hospital Universitario La Fe, Valencia, España. estornellmoragues@hotmail.com
Serrano Durbá
Agustín
A
Domínguez Hinarejos
Carlos
C
Ayuso González
Lidia
L
Martínez Verduch
Mario
M
García Ibarra
Fernando
F
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003558:Cystoscopy; D003911:Dextrans / Q000008:administration & dosage / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000009:adverse effects; D007267:Injections; D011138:Polytetrafluoroethylene / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D012828:Silicones / Q000008:administration & dosage / Q000009:adverse effects; D013997:Time Factors; D018666:Ureteroscopy; D014718:Vesico-Ureteral Reflux / Q000628:therapy*
D003911:Dextrans; D012828:Silicones; C487487:dextranomer-hyaluronic acid copolymer; C078211:polymethylsiloxane; D011138:Polytetrafluoroethylene; D006820:Hyaluronic Acid