Endoscopic Treatment of Vesicoureteral Reflux

Abstract

Vesicoureteral reflux (VUR) is one of the most common urological abnormalities, affecting 1-2% of the pediatric population and 25-40% of children presenting with urinary tract infection (UTI). The association of VUR, UTI, and renal parenchymal damage is widely recognized. Therefore, timely intervention is essential to prevent recurrent urinary tract infections and reduce the risk of permanent renal parenchymal damage and to minimize sequelae of reflux nephropathy. Since its first clinical application in the early 1980s and the approval of dextranomer/hyaluronic acid (Deflux®) by the US Food and Drug Administration (FDA) in 2001 as an acceptable tissue augmenting substance for subureteral injection, endoscopic treatment of VUR has gained worldwide popularity and is currently the first-line therapy for many infants and children with primary reflux. Over the years, multiple studies have demonstrated safety and long-term efficacy of this minimally invasive outpatient procedure, which has success rates of 77-83% after the first injection and can easily be repeated in cases of failure, with a high rate of subsequent resolution. Ureterovesical junction obstruction after endoscopic correction of VUR has been reported in less than 1% of treated cases and appears to be independent of the tissue augmenting substance, volume, and injection technique.