Long-term results of endoscopic treatment of vesicoureteral reflux in children: comparison of different bulking agents.
OBJECTIVE
To determine the long-term effect in children of endoscopic treatment of vesicoureteral reflux (VUR) using different bulking agents. VUR status, recurrence of urinary tract infection (UTI), and recurrence of febrile UTI were evaluated as endpoints.


METHODS
From 1993 to 2005, we injected 229 refluxive ureters (VUR grade II-IV) in 135 children. Mean age of the children was 55.7 months. We used collagen in 98 (years 1993-2000), polydimethylsiloxane in 32 (years 1999-2000), and dextranomer/hyaluronic acid copolymer (Dx/HA) in 99 ureters (years 2000-2005). Of the 135 children, 127 underwent a voiding cystourethrogram (VCUG) (radiologic or nuclid) 3 months after the first injection, and 88 children a second VCUG (nuclid) after 37 months (mean) postoperatively. Clinically, patients were monitored for non-febrile or febrile UTI. Data were collected and analyzed retrospectively by chart review.


RESULTS
After first injection with collagen, polydimethysiloxane and Dx/HA, 52%, 55% and 81.5% of the children were without VUR, respectively. Repeated injections were successful in only 21% (collagen) to 42% (Dx/HA). Of the 88 with a second VCUG, 48.5% of the initially reflux-free children developed relapse VUR after collagen, 45.5% after polydimethylsiloxane and 21.5% after Dx/HA injection. Clinically, there was a significant difference in postoperative UTI occurrence in favor of the Dx/HA group.


CONCLUSIONS
Clinically and radiologically, Dx/HA exhibited the best results, giving better protection against UTIs and a better VUR cure rate. There was still a risk of VUR recurrence in successfully treated children after 3 years of follow up.
Kinderchirurgische Klinik und Poliklinik im Dr. v. Haunerschen Kinderspital, Ludwig-Maximilians-Universität München, Lindwurmstr. 4, 80337 München, Germany.
Regina Johanna Franziska
RJ
Stredele
Hans-Georg
HG
Dietz
Maximilian
M
Stehr
D002675:Child, Preschool; D003094:Collagen / Q000008:administration & dosage*; D003911:Dextrans / Q000008:administration & dosage*; D004129:Dimethylpolysiloxanes / Q000008:administration & dosage*; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D015552:Injections, Intralesional / Q000379:methods; D008297:Male; D012189:Retrospective Studies; D055502:Secondary Prevention; D012828:Silicones / Q000008:administration & dosage*; D013995:Time; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000517:prevention & control; D014718:Vesico-Ureteral Reflux / Q000188:drug therapy* / Q000517:prevention & control
D003911:Dextrans; D004129:Dimethylpolysiloxanes; D012828:Silicones; C487487:dextranomer-hyaluronic acid copolymer; C013830:baysilon; D006820:Hyaluronic Acid; D003094:Collagen