title: Efficiency of endoscopic treatment for vesico-ureteric reflux in adults.
abstract: OBJECTIVE
  To evaluate the results of our experience with endoscopic management of vesico-ureteric reflux (VUR) in adults, and to describe factors and complications that might contribute to the failure of the technique.
  
  
  METHODS
  Between 1992 and 2006, 21 patients (17 women and four men; mean age 32.1 years, SD 15.6) had endoscopic treatment for VUR (14 unilateral and seven bilateral ureteric units, UU). Patients previously operated for VUR were excluded. The VUR grades were II, III, IV and V in 10, 12, five and one UUs, respectively. The main indication for treatment was a history of repeated episodes of acute pyelonephritis (61%). Complications after surgery were evaluated.
  
  
  RESULTS
  The success rate of the first endoscopic treatment was 69%, and was 81% after the second. Two UUs with grade IV VUR were endoscopically managed for a third time with complete resolution. Only one UU with grade V VUR required open surgery. The success rate for VUR grades II, III and IV after the first treatment was five of eight, 12/12 and one of five, respectively. After the second treatment the success rate increased to seven of eight and two of five for grades II and IV, respectively. There were no complications related to the intervention. Factors related to a failure of technique were duplex ureter and dysfunctional voiding in eight UUs (seven patients).
  
  
  CONCLUSIONS
  The endoscopic management of VUR in previously untreated adult patients is a simple and efficient technique, with low comorbidity.
authors.affiliation: Department of Urology, Fundació Puigvert, Cartagena, Barcelona, Spain. jacobo1976@hotmail.com
authors.forename: Jacobo
authors.initials: J
authors.lastname: Arce
authors.forename: Oriol
authors.initials: O
authors.lastname: Angerri
authors.forename: Jorge
authors.initials: J
authors.lastname: Caffaratti
authors.forename: José Maria
authors.initials: JM
authors.lastname: Garat
authors.forename: Humberto
authors.initials: H
authors.lastname: Villavicencio
mesh_terms: D000328:Adult; D003558:Cystoscopy / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D011704:Pyelonephritis / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D055502:Secondary Prevention; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000379:methods* / Q000592:standards; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000601:surgery*