title: Endoscopic treatment of symptomatic vesicoureteral reflux after renal transplantation.
abstract: OBJECTIVE
  We evaluated the success of endoscopic treatment of symptomatic vesicoureteral reflux after renal transplantation and identified factors predicting success.
  
  
  METHODS
  Endoscopy was performed for symptomatic vesicoureteral reflux after renal transplantation in 38 women and 20 men between January 2000 and December 2010. Reflux was documented by retrograde cystography and its symptomatic character was determined by at least 1 episode of acute graft pyelonephritis. The results of endoscopic treatment were evaluated clinically at 1 and 3 months, and annually, and by cystography at 3 months. Clinical success was defined as absent acute graft pyelonephritis during followup. Radiological success was defined as absent reflux on followup cystography at 3 months.
  
  
  RESULTS
  Endoscopic treatment was clinically successful in 32 patients (56.1%), including 26 (65%) who received dextranomer-hyaluronic acid and 5 (33.3%) who received polydimethylsiloxane. Treatment was radiologically successful in 14 patients (26.4%) at a mean ± SD followup of 38 ± 33 months. On multivariate analysis male gender and dextranomer-hyaluronic acid were factors predictive of clinical success. Reflux grade did not predict success or failure. No high grade complication was reported.
  
  
  CONCLUSIONS
  Endoscopic treatment of symptomatic vesicoureteral reflux of a transplanted kidney was effective in half of the cases regardless of the bulking agent used. However, dextranomer-hyaluronic acid appeared to be more effective than polydimethylsiloxane. Due to its minimally invasive nature and low morbidity endoscopic treatment with dextranomer-hyaluronic acid could be proposed as preoperative first line treatment for symptomatic vesicoureteral reflux of a transplanted kidney regardless of reflux grade.
authors.affiliation: Department of Urology and Kidney Transplantation, La Conception University Hospital, Marseille, France.
authors.forename: Akram
authors.initials: A
authors.lastname: Akiki
authors.affiliation: Department of Urology and Kidney Transplantation, La Conception University Hospital, Marseille, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Boissier
authors.affiliation: Department of Urology and Kidney Transplantation, La Conception University Hospital, Marseille, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Delaporte
authors.affiliation: Department of Urology and Kidney Transplantation, La Conception University Hospital, Marseille, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Maurin
authors.affiliation: Department of Urology and Kidney Transplantation, La Conception University Hospital, Marseille, France.
authors.forename: Sarah
authors.initials: S
authors.lastname: Gaillet
authors.affiliation: Department of Urology and Kidney Transplantation, La Conception University Hospital, Marseille, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Karsenty
authors.affiliation: Department of Urology and Kidney Transplantation, La Conception University Hospital, Marseille, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Coulange
authors.affiliation: Department of Urology and Kidney Transplantation, La Conception University Hospital, Marseille, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Lechevallier
mesh_terms: D000328:Adult; D000368:Aged; D003558:Cystoscopy; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018666:Ureteroscopy; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D055815:Young Adult
keywords: baysilon; dextranomer-hyaluronic acid copolymer; endoscopy; kidney transplantation; vesico-ureteral reflux