title: Is a secondary procedure necessary in every case of failed endoscopic treatment for vesicoureteral reflux?
abstract: OBJECTIVE
  Endoscopic treatment (ET) has become a widely accepted procedure for treating vesicoureteral reflux (VUR). However, patients followed up after ET over long periods have reported persistent or recurrent VUR. We evaluated the natural course of failed ET in patients who required further treatments to help physicians in making decisions on the treatment of VUR.
  
  
  METHODS
  We retrospectively reviewed the medical records of patients who were diagnosed with VUR and underwent ET from January 2006 to December 2009. A total of 165 patients with 260 ureters underwent ET. We compared the parameters of the patients according to ET success or failure and evaluated the natural course of the patients after ET failure.
  
  
  RESULTS
  Mean VUR grade and positive photon defect were higher in the failed ET group than in the successful ET group. Six months after the operation, persistent or recurrent VUR was observed in 76 ureters (29.2%), and by 16.3 months after the operation, VUR resolution was observed in 18 ureters (23.7%). Twenty-five ureters (32.9%) without complications were observed conservatively. Involuntary detrusor contraction was found in 1 of 9 (11.1%) among the secondary ET success group, whereas in the secondary ET failure group, 4 of 6 (66.7%) had accompanying involuntary detrusor contraction.
  
  
  CONCLUSIONS
  Patients in whom ET fails can be observed for spontaneous resolution of VUR unless they have febrile urinary tract infection or decreased renal function. Urodynamic study may be helpful in deciding whether a secondary procedure after ET failure is necessary.
authors.affiliation: Department of Urology, Catholic University of Daegu School of Medicine, Daegu, Korea.
authors.forename: Hyun Jin
authors.initials: HJ
authors.lastname: Jung
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young Jae
authors.initials: YJ
authors.lastname: Im
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Yong Seung
authors.initials: YS
authors.lastname: Lee
authors.affiliation: Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Myung Joo
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Han
mesh_terms: D002648:Child; D002675:Child, Preschool; D003558:Cystoscopy; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009130:Muscle, Smooth / Q000503:physiopathology*; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000503:physiopathology*; D014563:Urodynamics; D014718:Vesico-Ureteral Reflux / Q000628:therapy*
keywords: Child; Endoscopy; Urodynamics; Vesico-ureteral reflux