title: High success rate with new modified endoscopic treatment for high-grade VUR: A pilot study with preliminary report.
abstract: OBJECTIVE
  Despite the benefits of the minimally invasive endoscopic treatment for vesicoureteral reflux (VUR) it has a major drawback which is low success rate in high grade VUR. For overcoming this problem, we introduce a new modified technique of endoscopic treatment called periureteral injection technique (PIT).
  
  
  METHODS
  In a prospective study a total of 37 ureters in 19 boys and 14 girls were treated, including 3 bilateral cases. Of 37 units, 30 (81.1%) had grade IV and 7 (18.9%) had grade V primary VUR (18 right, 13 left and 3 bilateral units). Subureteral injection of Vantris(®) was done at the 5-o'clock and 7-o'clock positions in which the direction of injecting needles were almost parallel. Pre- and post-operative evaluation included urinalysis, urinary tract ultrasonography, voiding cystourethrography (VCUG), dimercaptosuccinic acid scan and urodynamic studies.
  
  
  RESULTS
  The median age was 38 months (range 8-125). At 6 months follow up period confirmed with VCUG, the VUR has been disappeared in 34 (91.8%) units and 3 units [2 (5.4%) grade II and 1 (2.7%) had grade III)] had downgraded VUR. Complications included early fever due to urinary tract infection in 1 children, transient dysuria in 2 patients and low back pain in one patient (Summary Table).
  
  
  CONCLUSIONS
  The success rate of PIT for treatment of high grade VUR is high. However, further studies with more patients and longer follow up periods are needed to draw final conclusion.
authors.affiliation: Urology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran. Electronic address: s_a_asgari@gums.ac.ir.
authors.forename: S A
authors.initials: SA
authors.lastname: Asgari
authors.affiliation: Urology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran. Electronic address: afshin_safaei2@yahoo.com.
authors.forename: A S
authors.initials: AS
authors.lastname: Asl
authors.affiliation: Clinical Center for Urological Disease Diagnosis and Private Clinic Specializing in Urological and Andrological Genetics, Tehran, Iran. Electronic address: info@safarinejad.com.
authors.forename: M R
authors.initials: MR
authors.lastname: Safarinejad
authors.affiliation: Urology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran. Electronic address: m_m_ghanaie@gums.ac.ir.
authors.forename: M M
authors.initials: MM
authors.lastname: Ghanaei
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000379:methods*; D014554:Urination / Q000502:physiology*; D013520:Urologic Surgical Procedures / Q000379:methods*; D014718:Vesico-Ureteral Reflux / Q000503:physiopathology / Q000601:surgery*
keywords: Endoscopy; Treatment outcome; Urologic surgical procedures/methods; Vesicoureteral reflux