title: Endoscopic treatment of vesicoureteral reflux in an adult population: Can we teach our adult urology colleagues?
abstract: OBJECTIVE
  Vesicoureteral reflux (VUR) is not well described or understood in adults. Since endoscopic correction of VUR has become a first-line therapy in children, we aimed to evaluate the efficacy of this technique in adult patients.
  
  
  METHODS
  In 1988-2008, 49 adult patients (6 males, 43 females) with a mean age of 33.6 years (range 18-64) underwent endoscopic treatment of VUR. Reflux was unilateral in 17 (34.7%) and bilateral in 32 (65.3%) patients, comprising 81 renal refluxing units (RRU). Of these, 71 (87.7%) were primary VUR. Reflux was Grade I in 14 (17%), Grade II in 46 (56.8%), Grade III in 17 (21%) and Grade IV in 4 (4.9%) RRU. Median renal function at surgery was 41.2%. Endoscopic correction utilized polytetrafluoroethylene (Teflon) in 38 (77.6%) and dextranomer/hyaluronic acid copolymer in 11 (22.4%) patients. Recurrent febrile urinary tract infection (UTI) was the only indication for surgery. Grade I VUR was treated only in patients with contralateral high-grade VUR.
  
  
  RESULTS
  The reflux was corrected in 63 (77.8%) RRU after a single injection, after second injection in 9 (10.6%) and after third in 4 (4.8%) RRU. In 3 (3.5%) RRU, VUR improved to Grade I. In 2 (2.4%), endoscopic correction failed, leading to open reimplantation. One patient with corrected VUR underwent nephrectomy due to non-functioning kidney and recurrent pyelonephritis. Fourteen (28.6%) patients suffered afebrile UTI. Five (10.2%) developed febrile UTI following successful endoscopic correction, leading to a diagnosis of VUR recurrence in two (4.1%) patients.
  
  
  CONCLUSIONS
  Endoscopic correction of VUR in adults is a simple and effective procedure, as in pediatric practice.
authors.affiliation: Division of Pediatric Urology, Shaare Zedek Medical Center, Faculty of Medical Science, Hebrew University, Jerusalem, Israel.
authors.forename: Alaeddin
authors.initials: A
authors.lastname: Natsheh
authors.forename: Ofer Z
authors.initials: OZ
authors.lastname: Shenfeld
authors.forename: Amicur
authors.initials: A
authors.lastname: Farkas
authors.forename: Boris
authors.initials: B
authors.lastname: Chertin
mesh_terms: D000293:Adolescent; D000328:Adult; D003911:Dextrans / Q000008:administration & dosage*; D004724:Endoscopy; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007267:Injections; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene / Q000008:administration & dosage*; D019736:Prostheses and Implants; D014718:Vesico-Ureteral Reflux / Q000628:therapy*; D055815:Young Adult
chemical_list: D003911:Dextrans; C094535:deflux; D011138:Polytetrafluoroethylene; D006820:Hyaluronic Acid