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

Objectives To report our experience with endoscopic management of vesicoureteral reflux (VUR) by injection of a tissue bulking substance–Dextranomer/ hyaluronic acid copolymer at vesicoureteric junction. Design Retrospective analyses of case records. Setting Pediatric Surgery department in a tertiary care government Institute. Participants 500 children (767 renal units) consecutively referred to the out-patient department with vesicoureteral reflux noted on micturating cysto-urethrogram (MCU) over a period of 13 years (2004-2016). Intervention Preoperative VUR grading and renal scars on radionuclide scans were documented. Dextranomer hyaluronic acid copolymer was injected through a cystoscope at the vesicoureteral junction as a day care procedure under short anesthesia. Patients were followed (average duration 27.3 mo) with clinical assessment, periodic urine cultures and renal scans. Main outcome measure Cessation of VUR and symptomatic relief / 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 substances at vesicoureteric junction to stop VUR seems to be an effective intervention