[Endoscopic treatment of primary vesicoureteral reflux in childhood. Review of 989 cases in a 9 years period].
OBJECTIVE
The primary vesicoureteral reflux (PVUR) is the most common urologic pathology during childhood and affects from 1 to 3% of newborn. It causes acute pyelonephritis (APN) and renal damage in addition to hospital visits with high economic and social costs. Nowadays the endoscopic treatment (ETR) seems to be the most suitable one for the reflux, due to its lower biological cost and its good results. We report our experience in the endoscopic treatment of the primary vesicoureteral reflux (ETR) in Murcia Pediatric Hospital from 1998 to 2007.


METHODS
We present a retrospective study describing 989 patients (1498 ureters) treated by means of ETR. All patients were treated with chemoprophylaxis since the moment of the diagnosis. ETR was fulfilled by the surgeon in an ambulatory way and with Sevofluorano. Deflux, Macroplastique and Coaptite were used. Age, stade, number of ETR, material, chemoprophylaxis, ureterocistoneostomy and ETR costs were evaluated.


RESULTS
One-thousand four-hundred and ninty-eight ureteral units, corresponding to 989 patients, (51,2% males), at ages from 4 months to 21-years-old, have been treated by means of ETR. The average age was 4-years-old. Grade III reflux was the most common of all, with 801 ureters affected. Deflux was used in 777 patients, Macroplastique in 203 and Coaptite in 9. No problems in early post-operation happened and the average length was shorter than 2 hours. Forty-eight hours after, 7 patients had to be treated due to APN. Four patients showed late litiasis related to ETR. Two suffered litotomy. The 89.9% of the patients were cured at first ETR. The 11.2% needed a second ETR, with 2.12% of failure (21 patients). Six cured with the third injection and 2 needed a fourth ETR. Thirteen children were treated with ureterocistoneostomy. Radiological correction have not relation with PVUR level and does not show significant differences. Failure regarding the used material was around 9% for Deflux, 11.8% for Macroplastique and 66.6% for Coaptite. The cost of ETR was 1.400 euros, the cost of ureterocistoneostomy 4.822 euros and of the chemoprophylaxis 4.158,7 euros per year.


CONCLUSIONS
From our experience, ETR is a method as safe as surgery and with less morbility. It is, furthermore, much more predictable than chemoprophylaxis and implies lower economical, biological and social costs than those other methods. In case of failure, ETR does not prevent any other kind of treatment. We regard ETR as a first order therapeutic gesture when dealing with PVUR.
Nortes Cano
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Sección de Urología Pediátrica, Servicio de Cirugía Pediátrica, USP San Carlos, Hospital Universitario Virgen de la Arrixaca, Murcia. leonortes@hotmail.com
Zambudio Carmona
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Guirao Piñera
M J
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Ruiz Jiménez
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