Endoscopic management of vesicoureteral reflux in adult women.
OBJECTIVE
• To describe our endoscopic management of adult women with vesicoureteral reflux (VUR) and associated outcomes.


METHODS
• We retrospectively identified 19 adult women who presented for the endoscopic treatment of VUR from November 2001 to January 2008. • Each patient was diagnosed with VUR by voiding cystourethrogram or nuclear cystourethrogram after an episode of pyelonephritis or recurrent urinary tract infections with renal scarring on ultrasound. • A dimercaptosuccinic acid renal scan was performed prior to treatment. All patients underwent endoscopic treatment with dextranomer/hyaluronic acid copolymer (Deflux). Patients with bilateral VUR received bilateral injections during the same procedure. • Follow-up imaging was obtained and success was strictly defined as no degree of VUR. Patients with residual VUR received repeat endoscopic treatment.


RESULTS
• Nineteen patients with a mean age of 22 years old (range 18-33 years old) underwent endoscopic treatment for VUR. A total of 79% (15/19) had pre-existing risk factors for VUR, including prior open anti-reflux surgery (26%), family history of VUR (26%) and childhood diagnosis of VUR (26%). • Imaging revealed that 47% (9/19) had renal scarring and 26% (5/19) had bilateral VUR. The success rate was 79% (19/24) after one treatment, 92% (22/24) after 5 patients received a second treatment, and 96% (23/24) after 2 patients received a third treatment. There were no perioperative complications.


CONCLUSIONS
• Endoscopic management of VUR is both safe and effective in adult women.
Columbia University Medical Center, Department of Urology, New York, NY, USA.
Alana M
AM
Murphy
Chad R
CR
Ritch
Elizabeth A
EA
Reiley
Terry W
TW
Hensle
D000293:Adolescent; D000328:Adult; D003558:Cystoscopy / Q000379:methods*; D003911:Dextrans / Q000627:therapeutic use*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D011704:Pyelonephritis / Q000150:complications; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000379:methods*; D014552:Urinary Tract Infections / Q000150:complications; D014718:Vesico-Ureteral Reflux / Q000209:etiology / Q000601:surgery*; D055815:Young Adult
D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid