[Endoscopic treatment of vesicoureteral reflux in children].

Background: At Rikshospitalet, Norway, vesicoureteral reflux (VUR) in children has been treated with subureteric teflon (polytetrafluoroethylen) injection (STING) since 1994. After a biological injection substance became commercially available, we changed to Deflux (dextranomer/hyaluronic acid) in 2000. The aim of this study was to assess whether the VUR results following use of the new injection substance are comparable to those for the previously used substance.

Material And Methods: 202 ureters with VUR grade II-V in 132 patients (91 girls) were treated for the first time with subureteric injections of teflon (n = 77) or Deflux (n = 125) during the 5-year period November 1998-2003. The charts were retrospectively reviewed.

Results: 201 ureters (131 patients) were followed up with urinary tract ultrasound and voiding cystogram 1-34 months after the last injection. After the first teflon injection 43% of the ureters had no reflux and an additional 9% were improved. After the first Deflux injection 48 % of the ureters had no reflux and 10% were improved. After 1-3 injections 78% (teflon 71%, Deflux 81%) were without or had reduced VUR. Three ureters showed terminal stenosis after the first Deflux injection. Statistically, the results were independent of VUR grade, injection substance and surgeon experience, and similar for duplex and single ureters.

Interpretation: Endoscopic treatment of VUR in children is safe and simple. The results after Deflux and teflon were similar. Urinary tract ultrasound and voiding cystogram should be used for follow-up of all patients some months after injection.