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

Objective: To report our experience with endoscopic management of vesicoureteral reflux (VUR) by injection of a tissue bulking substance - Dextranomer/ hyaluronic acid co-polymer 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.

Conclusions: Endoscopic injection of tissue bulking substances at vesicoureteric junction to stop VUR seems to be an effective intervention.