Endoscopic Management of Vesicoureteral Reflux and Long-term Follow-up

ABSTRACT

Objectives: To report our experience with endoscopicmanagement of vesicoureteral reflux (VUR) by injection of atissue bulking substance – Dextranomer/ hyaluronic acid co-polymer at vesicoureteric junction.Design: Retrospective analyses of case records.Setting: Pediatric Surgery department in a tertiary caregovernment Institute.Participants: 500 children (767 renal units) consecutivelyreferred to the out-patient department with vesicoureteral refluxnoted on micturating cysto-urethrogram (MCU) over a period of13 years (2004-2016).Intervention Preoperative VUR grading and renal scars onradionuclide scans were documented. Dextranomer hyaluronicacid copolymer was injected through a cystoscope at thevesicoureteral junction as a day care procedure under shortanesthesia. Patients were followed (average duration 27.3 mo)with clinical assessment, periodic urine cultures and renal scans.Main outcome measure: Cessation of VUR and symptomaticrelief / clinical success postoperatively at 3 months.Results: Complete symptomatic relief was obtained in 482(96.4%) patients. In 681 units where MCU was available, 614(90%) units showed resolution of VUR.Conclusion: Endoscopic injection of tissue bulking substancesat vesicoureteric junction to stop VUR seems to be an effectiveintervention