title: Efficacy of endoscopic subureteral injection for vesicoureteral reflux in adults with decreased bladder compliance.
abstract: OBJECTIVE
  To evaluate the outcome of endoscopic subureteral injection (ESI) in adults with vesicoureteral reflux (VUR) associated with decreased bladder compliance (D-BC).
  
  
  METHODS
  We retrospectively reviewed the medical records of 46 consecutive patients who underwent ESI for VUR at a single tertiary academic center. Fourteen patients (17 ureter units) who had underlying neurological disease with decreased bladder compliance, as determined by filling cystometry, were grouped as D-BC. Thirty-two patients (47 units) who had no signs or symptoms that suggested neurogenic lower urinary tract dysfunctions were grouped as normal bladder compliance (N-BC). We compared the cure rates for ESI between groups, defining cure as complete resolution of reflux on voiding cystourethrogram.
  
  
  RESULTS
  In 70.6% of the D-BC group and 70.2% of the N-BC group, VUR resolved completely after the first injection (P = 0.977). One failed unit of D-BC was cured after second ESI, and seven failed units of N-BC were cured after additional treatments (second ESI, two patients; ureteroneocystostomy, five patients). No additional treatments were applied to three units of D-BC or seven units of N-BC without symptoms. No complications related to the ESI were observed.
  
  
  CONCLUSIONS
  The ESI was found to be effective in adults with VUR regardless of the bladder compliance. As a minimally invasive procedure with a favorable outcome, ESI may represent the first choice for treatment of VUR even in adults with D-BC.
authors.affiliation: Department of Urology, Sungkyunkwan University School of Medicine, Clinical Trial Center, Samsung Medical Center, Seoul, South Korea.
authors.forename: Kyu Sung
authors.initials: KS
authors.lastname: Lee
authors.forename: Deok Hyun
authors.initials: DH
authors.lastname: Han
authors.forename: Jae Yong
authors.initials: JY
authors.lastname: Jeong
authors.forename: Young Suk
authors.initials: YS
authors.lastname: Lee
authors.forename: Jae Wook
authors.initials: JW
authors.lastname: Ko
mesh_terms: D000328:Adult; D000368:Aged; D003911:Dextrans / Q000008:administration & dosage*; D004129:Dimethylpolysiloxanes / Q000008:administration & dosage*; D004724:Endoscopy; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007267:Injections / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014513:Ureter; D001743:Urinary Bladder / Q000503:physiopathology*; D014718:Vesico-Ureteral Reflux / Q000503:physiopathology* / Q000628:therapy*; D055815:Young Adult
chemical_list: D003911:Dextrans; D004129:Dimethylpolysiloxanes; C487487:dextranomer-hyaluronic acid copolymer; C013830:baysilon; D006820:Hyaluronic Acid