title: Is endoscopic injection therapy a reasonable treatment option for low-grade vesicoureteral reflux in association with overactive bladder?
abstract: OBJECTIVE
  To assess the clinical outcome of endoscopic injection in children with vesicoureteral reflux (VUR) and concomittant overactive bladder (OAB).
  
  
  METHODS
  A total of 41 patients with VUR and OAB underwent endoscopic injection of dextranomer/hyaluronic acid. At surgery, 13 patients had been successfully treated for their OAB (urgency with or without wetting) with behavior modification with or without anticholinergic therapy, and 28 had persistent OAB despite treatment. Voiding cystourethrogram was obtained 6-12 weeks postoperatively, and patients were followed up clinically for 1-5 years.
  
  
  RESULTS
  Negative voiding cystourethrogram findings after a single treatment were seen in 34 (82.9%) of 41 patients. The radiographic success rate in patients with well-controlled OAB was 76.9% (10 of 13) compared with 85.7% (24 of 28) of those with poorly controlled OAB. The overall clinical success rate, defined as no evidence of urinary tract infection in the setting of negative voiding cystourethrogram findings, reached 78.0% (32 of 41). After successful endoscopic treatment, an unanticipated return to normal voiding patterns without the need for postoperative anticholinergic therapy was seen in 4 of the children with well-controlled OAB (40.0%) and in 4 with poorly controlled OAB (16.7%).
  
  
  CONCLUSIONS
  Our data suggest that endoscopic injection is a viable treatment option for VUR in those with OAB, with postoperative rates of resolution comparable to those found in patients without OAB. Furthermore, 40.0% of children with well-controlled OAB no longer required therapy for OAB after resolution of their VUR.
authors.affiliation: Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia 30342, USA.
authors.forename: Kate H
authors.initials: KH
authors.lastname: Kraft
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Molitierno
authors.forename: Liisa
authors.initials: L
authors.lastname: Dewhurst
authors.forename: Christine
authors.initials: C
authors.lastname: Geers
authors.forename: Kristin
authors.initials: K
authors.lastname: Gunderson
authors.forename: Hal C
authors.initials: HC
authors.lastname: Scherz
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kirsch
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003911:Dextrans / Q000008:administration & dosage*; D004724:Endoscopy; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007267:Injections; D008297:Male; D053201:Urinary Bladder, Overactive / Q000150:complications*; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000628:therapy*
chemical_list: D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid