The effect of location of the ureteric orifice on the efficacy of endoscopic injection to correct vesico‐ureteric reflux

• Published in: BJU international 2005-06, Vol.95 (9), p.1314-1318
• Main Authors: Yucel, Selcuk, Ucar, Murat, Guntekin, Erol, Kukul, Erdal, Melikoglu, Mustafa, Baykara, Mehmet
• Format: Article
• Language: English
• Subjects: Adolescent; Biological and medical sciences; Child; Child, Preschool; dextranomer; Diseases of the urinary system; endoscopy; Female; Humans; hyaluronic acid; Injections, Intralesional; Male; Medical sciences; Nephrology. Urinary tract diseases; polydimethylsiloxane; Polytetrafluoroethylene - administration & dosage; PTFE; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; treatment; Ureter - abnormalities; ureteric orifice; Ureteroscopy; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Vesico-Ureteral Reflux - pathology; Vesico-Ureteral Reflux - therapy; vesico‐ureteric reflux
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2005.05525.x

OBJECTIVE To review our 11‐year experience and identify the mechanisms responsible for the failure of endoscopic injection for vesico‐ureteric reflux (VUR) with three different injectable agents, based on the location of the ureteric orifice on endoscopy. PATIENTS AND METHODS We retrospectively reviewed the charts and endoscopic video‐photographs of 46 patients (26 girls, 20 boys, median age 6 years, range 2–16) with VUR treated once or twice by subureteric injection with PTFE, or polydimethylsiloxane or dextranomer/hyaluronic acid copolymer, from 1992 to 2003. Five patients were lost to follow‐up and six ectopic and/or duplicated ureters were excluded from the analysis; in all, 52 ureters were analysed. According to the international classification, the VUR was grades I to V in four (8%), 12 (23%), 16 (31%), 13 (25%) and seven (13%) ureters, respectively. RESULTS After 3 months, voiding cysto‐urethrography showed that VUR continued in six of 19, seven of 12 and eight of 21 ureters (38%), respectively, after subureteric PTFE, polydimethylsiloxane and dextranomer/hyaluronic acid copolymer injection; after the second injection, reflux continued in two of six, four of seven and three of eight ureters, respectively. Mound displacement and/or volume loss was the most common failure with all three bulking agents after both the first (62%) and second injections (44%) (P