title: Is a third endoscopic treatment for vesicoureteral reflux indicated if previous attempts have failed?
abstract: OBJECTIVE
  To evaluate the efficacy of a third endoscopic injection to correct vesicoureteral reflux (VUR).
  
  
  METHODS
  This was a prospective study of 605 patients, of whom 42 (6.4%), involving 44 (4%) ureteral units, received a third injection. The results were analysed regarding VUR grade and aetiology, substance used, volume, location and morphology of the mound, presence of poor prognostic factors, the urologist's experience, and complications.
  
  
  RESULTS
  The treatment resolved the VUR in 38 (86.4%) units, 22 of primary cause (91.6%) and 16 with anatomical/functional abnormalities (80%) (no significant difference; P = 0.26). There was also no significant difference in success rate with regard to the substance injected (P = 0.23), the degree of VUR (P = 0.76) or the volume injected (P = 0.17). The success rate was higher (96.9%) if a less experienced urologist had performed the previous procedure versus a more experienced urologist (54.5%), and this difference was significant (P < 0.005). There was one complication (haematuria) (2.3%).
  
  
  CONCLUSIONS
  Third treatment presents a similar efficacy to first and second treatments, with a very low rate of complications, and could be indicated before open surgery.
authors: Children's Urology Department, Hospital Universitari i Politècnic La Fe, Bulevar Sur s/n, 46026 Valencia, Spain. slujanmarco@comv.es
authors: S
authors: S
authors: Luján
authors: A
authors: A
authors: Serrano
authors: C
authors: C
authors: Domínguez
authors: F
authors: F
authors: Estornell
authors: F
authors: F
authors: García-Ibarra
mesh_terms: D002648:Child; D002675:Child, Preschool; D003911:Dextrans / Q000008:administration & dosage; D004129:Dimethylpolysiloxanes / Q000008:administration & dosage; D004724:Endoscopy; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage; D007223:Infant; D007267:Injections; D008297:Male; D019736:Prostheses and Implants; D019233:Retreatment; D017211:Treatment Failure; D014718:Vesico-Ureteral Reflux / Q000503:physiopathology / Q000628:therapy*
chemical_list: D003911:Dextrans; D004129:Dimethylpolysiloxanes; C487487:dextranomer-hyaluronic acid copolymer; C013830:baysilon; D006820:Hyaluronic Acid