Archives of Hellenic Medicine

Last update:

29-Nov-2023

Arch Hellen Med, 40(6), November-December 2023, 779-785

ORIGINAL PAPER

Endoscopic injection treatment of vesicoureteral reflux in children
A ten-year initial experience at a single Greek institution

S. Roupakias,¹ X. Sinopidis,¹ A. Tzantzaroudi,² I. Spyridakis,³ A. Karatza,⁴ A. Varvarigou,⁴ G. Tsikopoulos²
¹Department of Pediatric Surgery, University General Hospital of Patras, University of Patras, Medical School, Patra
²Department of Pediatric Surgery, "Hippocrateio" General Hospital, Thessaloniki
³Second Department of Pediatric Surgery, "Papageorgiou" University General Hospital, Aristotelian University of Thessaloniki, Medical School, Thessaloniki
⁴Department of Pediatrics, University General Hospital of Patras, University of Patras, Medical School, Patra, Greece

OBJECTIVE To present our initial experience with endoscopic vesicoureteral reflux (VUR) management and investigate the predictive value of factors that could influence its outcome.

METHOD The records of 79 children who had undergone endoscopic injection treatment (EIT) during the last ten years were examined. The following were included into the study as investigated and analyzed parameters: sex, age, VUR grade, VUR side, VUR bilaterality, VUR timing on voiding cystourethrogram (VCUG), preoperative relative renal function in dimercaptosuccinic acid (DMSA) scintigraphy, presentation of ureteral duplication, reinjection attempts, postoperative febrile urinary tract infection (UTI) and outcome.

RESULTS VUR was successfully resolved with endoscopy in 88/120 ureters (73.3%) after 1–3 injections, and finally, 24/120 ureters (20%) underwent reimplantation. Children ≥6 years of age, girls, left-sided ureters, and ureters or children without duplication system, seem to be better candidates for successful EIT. Children with bilateral VUR, children presenting post-injection febrile UTI, and ureters with higher grade VUR, presented significant failure in EIT cure rates.

CONCLUSIONS EIT is a safe and viable alternative option against open surgical ureteral reimplantation and long-term antibiotic prophylaxis. Reflux grades II–III present successful outcomes after EIT. Repeated injections after EIT failure were less satisfactory in grade IV and unsuccessful in grade V reflux. EIT needs further evaluation of long-term outcomes to implement predictive risk factors.

Key words: Endoscopic injection treatment, Outcome, Risk factors, Vesicoureteral reflux.