Unilateral vesicoureteral reflux and history of contralateral vesicoureteral reflux warranting routine bilateral endoscopic correction.
OBJECTIVE
It has been shown that the incidence of de novo vesicoureteral reflux following unilateral endoscopic correction is low and does not justify prophylactic injection into the nonrefluxing ureter. We analyzed whether we should routinely treat each ureter in patients with a history of bilateral vesicoureteral reflux in whom reflux previously disappeared spontaneously on 1 side.


METHODS
Between 1991 and 2005, 458 children underwent endoscopic correction of unilateral vesicoureteral reflux. Of the children 15 with bilateral vesicoureteral reflux at the beginning of followup showed spontaneous reflux resolution on 1 side. Resolved reflux was grade II to IV in 5, 8 and 2 children, respectively. Mean time to reflux resolution was 3.3 years (range 2 to 5). Reflux corrected endoscopically was grade II to IV in 1, 6 and 8 children, respectively. All children were female and age at endoscopic correction was 2 to 16 years. None of the children had voiding dysfunction at the time of injection. Injection was performed routinely only into the refluxing ureter. Configuration of the orifice of the ureter with resolved vesicoureteral reflux was recorded at injection.


RESULTS
Vesicoureteral reflux was corrected in all except 1 ureter, in which reflux was downgraded to grade I. The configuration of the orifice of the ureter with resolved reflux was normal in all children. Of the 15 children 14 (93%) showed recurrent vesicoureteral reflux in previously resolved ureters. Recurrent reflux grade was I to III in 1 (7.1%), 6 (42.8%) and 7 children (50%), respectively. All children required endoscopic correction on the side of recurrence due to high grade reflux in 7 and breakthrough urinary tract infection in the remaining 7. In 2 cases (14.2%) renal scan revealed new renal scarring.


CONCLUSIONS
There is a high incidence of recurrent vesicoureteral reflux in previously resolved ureters following endoscopic correction on the contralateral side. Therefore, we recommend routine injection of the 2 ureters in patients with a history of bilateral vesicoureteral reflux.
Chertin
Boris
B
Department of Urology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel. bchertin@yahoo.com
Natsheh
Alaeddin
A
Fadeev
Dmitry
D
Shenfeld
Ofer Z
OZ
Farkas
Amicur
A
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003911:Dextrans / Q000008:administration & dosage*; D004724:Endoscopy; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D019736:Prostheses and Implants; D012189:Retrospective Studies; D055502:Secondary Prevention; D014718:Vesico-Ureteral Reflux / Q000473:pathology / Q000517:prevention & control*
D003911:Dextrans; C094535:deflux; D006820:Hyaluronic Acid