Abstract
Purpose: Aim of the study was to analyse the success rate of endoscopic treatment (ET) using
Dx/HA for primary vesicoureteral reflux (VUR) in children and to assess the incidence
of postoperative urinary tract infections (UTIs).
Methods: We retrospectively reviewed the charts of 103 children with VUR grade II-V who underwent
ET, including children with additional urogenital malformations. Outcomes were verified
with voiding cystourethrography (VCUG) and periodical urinalysis.
Results: 103 children with a total of 174 ureters underwent ET. 71 patients presented with
bilateral VUR. Additional malformations were: duplex ureters (19 patients), posterior
urethral valves (PUV) (12 patients), diverticulum (4 patients), neurogenic bladder
and ectopic orifice. VUR grade was II in 52, III in 74, IV in 41 and V in 7 ureters,
respectively. Postoperative VCUG demonstrated no VUR in 140 ureters (80%) and diminished
VUR grade in an additional 18 ureters (total 91%). After a second ET, VCUG was negative
in 28 ureters. The overall success rate was 98%. 30 patients had had more than 3 febrile
and 67 patients had had 1–3 febrile UTIs before ET. 4 out of 103 patients (3.9%) had
1 febrile UTI within the first year of follow-up. Serious complications after ET were
not noted.
Conclusion: ET is effective at eliminating VUR in children, even in patients with high-grade
reflux, as well as in patients with VUR and additional malformations. Early intervention
may reduce the incidence of UTIs and prevent long-term renal damage.
Key words
vesicoureteral reflux - endoscopic injection - dextranomer gel/hyaluronic acid - urinary
tract infection - children
References
Correspondence
frankmartin.haecker@ukbb.ch
