title: Endoscopic treatment of vesicoureteral reflux in children with posterior urethral valves.
abstract: OBJECTIVE
  We reviewed the clinical outcome of endoscopic injection therapy in children with vesicoureteral reflux persisting after posterior urethral valve ablation.
  
  
  METHODS
  We retrospectively reviewed the charts of 16 patients with posterior urethral valves who have undergone endoscopic injection to correct persistent reflux after successful relief of urethral obstruction. Breakthrough urinary tract infections, persistent high-grade reflux and failed ureteroneocystostomy were the indications of endoscopic antireflux surgery.
  
  
  RESULTS
  Reflux was grade I in 1, grade II in 3, grade III in 11 and grade IV in 4 ureters. Mean age at injection was 6.9 ± 3.8 years and the mean interval from initial intervention to injection was 4.3 ± 2.4 years. Injected material was dextranomer/hyaluronic acid in the majority (87.5 %) of cases. Reflux was resolved or downgraded in 12 ureters (63.1 %) after a single injection. All failed cases had urodynamically documented bladder dysfunction.
  
  
  CONCLUSIONS
  More than half of the patients with vesicoureteral reflux, persisting after initial valve ablation, showed complete resolution or significant downgrading in their reflux grade after endoscopic injection. Given the technical difficulties and potential complications of open surgical reimplantation in valve patients, endoscopic subureteral injection can be considered as an effective alternative to cure persistent vesicoureteral reflux.
authors: Department of Urology, Istanbul Faculty of Medicine, Istanbul University, 34093 Capa, Istanbul, Turkey. tayfunoktar@hotmail.com
authors: Tayfun
authors: T
authors: Oktar
authors: Omer
authors: O
authors: Acar
authors: Ahmet
authors: A
authors: Sancaktutar
authors: Oner
authors: O
authors: Sanlı
authors: Tzevat
authors: T
authors: Tefik
authors: Orhan
authors: O
authors: Ziylan
mesh_terms: D001672:Biocompatible Materials / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003911:Dextrans / Q000008:administration & dosage*; D004724:Endoscopy; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007267:Injections; D011183:Postoperative Complications / Q000628:therapy*; D012189:Retrospective Studies; D014521:Urethra / Q000601:surgery; D014563:Urodynamics; D014718:Vesico-Ureteral Reflux / Q000628:therapy*
chemical_list: D001672:Biocompatible Materials; D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid