title: The outcome of initial endoscopic treatment in the management of concomitant vesicoureteral reflux and ureteropelvic junction obstruction.
abstract: OBJECTIVE
  To report the results of a single-center experience with the endoscopic injection of Deflux as the initial minimally invasive approach in patients with vesicoureteral reflux (VUR) and coexisting obstruction at the ureteropelvic junction (UPJO) level who presented with VUR.
  
  
  METHODS
  Between May 2004 and July 2011, 2810 children with a diagnosis of VUR were referred to our center; 143 (5%) had concomitant UPJO. On the basis of the study inclusion criteria, 76 were included. All patients received antibiotic therapy. VUR and UPJO resolved in 50 children without the need for further intervention, and 26 underwent endoscopic Deflux injection by applying the hydrodistention autologous blood injection technique (HABIT). All patients received antibiotic prophylaxis until resolution of VUR was confirmed on voiding cystourethrogram (VCUG). Patients underwent follow-up visits at 1, 6, and 12 months postoperatively.
  
  
  RESULTS
  At a mean follow up of 20.0 ± 1.6 months, 20 of those with concomitancy showed resolution of VUR and the coexisting UPJO after the first injection (success rate, 76.9%), and 2 resolved after the second injection, leading to an overall success rate of 84.6%. Finally, 3 patients required further ureteral reimplantation, and 3 underwent pyeloplasty for correction of UPJO by applying miniature pyeloplasty technique. Differential renal function was preserved in all patients.
  
  
  CONCLUSIONS
  Performing an initial endoscopic injection of Deflux in the management of concomitant VUR and UPJO provides promising results in terms of spontaneous resolution of obstruction at the UPJ level and complete resolution or decrease in hydronephrosis.
authors.affiliation: Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran. kajbafzd@sina.tums.ac.ir
authors.forename: Abdol-Mohammad
authors.initials: AM
authors.lastname: Kajbafzadeh
authors.forename: Ali
authors.initials: A
authors.lastname: Tourchi
authors.forename: Maryam
authors.initials: M
authors.lastname: Ebadi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003911:Dextrans / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007267:Injections; D007682:Kidney Pelvis; D008297:Male; D019736:Prostheses and Implants; D012189:Retrospective Studies; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000150:complications / Q000628:therapy*; D018666:Ureteroscopy / Q000379:methods*; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000628:therapy*
chemical_list: D003911:Dextrans; C094535:deflux; D006820:Hyaluronic Acid