Endoscopic Treatment of Vesicoureteral Reflux: Changing Trends Over the Years
Journal of Urological Surgery
Objective: To investigate factors affecting the success rate of endoscopic subureteral injection (ESI) in patients with vesicoureteral reflux (VUR) and to evaluate the changes in years. Materials and Methods: A total of 439 patients with primary VUR who underwent ESI were included. We used dextranomer hyaluronic acid copolymer (Dx-HA) as bulking agent. Statistical analyzes were performed by SPSS 20.0 programme. Results: Overall patient-based and renal unit-based success rates of ESI were 75.6%
... of ESI were 75.6% and 78.2%, respectively. Operational age of 82 months and lower grades of VUR were found to be the factors increasing success rate (p=0.023, p=0.005). Success rates were as 83.6%, 77.9% and 64.5% for grades of reflux 1-2, 3 and 4-5, respectively (p=0.002). When patients were seperated into four equal chronological groups, we observed that the ratio of patients who had previous failed ESI, high-grade reflux and renal scarring and volume of injected material has increased over the years. Conclusion: ESI has higher success rates in older children and lower grades (grades 1-3) of VUR. It is performed also in high-grade patients with acceptable success rates which tended to increase over the years. Abstract What's known on the subject? and What does the study add? Endoscopic subureteral injection (ESI) is an easy and minimally invasive procedure and may be an alternative to open surgery and continuous antibiotic prophylaxis by offering some advantages in patients with vesicoureteral reflux (VUR). In our study, we detected that the rate of patients with history of failed ESI, high grade reflux and renal scarring have increased significantly in our patient population over time. ESI is increasingly preferred with our increasing surgical experience over the years in patients who failed after the first ESI and especially in those with high grade VUR and appropriate ureter configuration on cystoscopy.