Efficacy of endoscopic subureteral injection for vesicoureteral reflux in adults with decreased bladder compliance.
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.
Lee
Kyu Sung
KS
Department of Urology, Sungkyunkwan University School of Medicine, Clinical Trial Center, Samsung Medical Center, Seoul, South Korea.
Han
Deok Hyun
DH
Jeong
Jae Yong
JY
Lee
Young Suk
YS
Ko
Jae Wook
JW
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
D003911:Dextrans; D004129:Dimethylpolysiloxanes; C487487:dextranomer-hyaluronic acid copolymer; C013830:baysilon; D006820:Hyaluronic Acid