title: Endoscopic correction of vesicoureteric reflux: 10-year experience of a tertiary care center.
abstract: Endoscopic treatment (ET) of vesicoureteric reflux (VUR) is becoming the new gold standard for surgical correction. ET for VUR using newly available bulking agents is a reliable and safe alternative procedure to open ureteral reimplantation for the treatment of VUR in children. We retrospectively reviewed our experience over 10 years of patients with primary VUR who underwent ET and had at least one year of follow-up at our center from 1998 to 2008. We looked at laterality, success rate, need for a second procedure and complication rate. We observed 321 patients with ET for VUR during this period; 115 (35.8%) of them were males and the total intervened ureters were 480. Correction of VUR was defined as either the resolution of reflux or a downgrading to grade 1 revealed with a follow-up voiding cystourethrogram and no ipsilateral renal or ureteric dilatation detected on renal ultrasound. At two to three months of follow-up, VUR was corrected in 393/480 (81.8%) refluxing ureters after a single endoscopic injection. With a second, repeated injection in the failed cases, VUR was corrected in a total of 418 (87.1%) refluxing ureters. Only three patients had post-operative complications (<1%). We conclude that our study suggests that the majority of patients will be cured after undergoing, as out-patients, this endoscopic procedure. We believe that the widely reported safety of bulking agents and the short learning curve will make ET the standard treatment for VUR once surgical correction is warranted.
authors.affiliation: Department of Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia. kfouda@ksu.edu.sa
authors.forename: Khalid Fouda
authors.initials: KF
authors.lastname: Neel
mesh_terms: D003911:Dextrans / Q000008:administration & dosage; D004129:Dimethylpolysiloxanes / Q000008:administration & dosage; D004724:Endoscopy / Q000009:adverse effects; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage; D007267:Injections; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D012529:Saudi Arabia; D013997:Time Factors; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000009:adverse effects; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*
chemical_list: D003911:Dextrans; D004129:Dimethylpolysiloxanes; C094535:deflux; C013830:baysilon; D006820:Hyaluronic Acid