Endoscopic management of vesicoureteral reflux in adult women

BJU Int. 2011 Jul;108(2):252-4. doi: 10.1111/j.1464-410X.2010.09824.x. Epub 2010 Nov 11.

Abstract

Objective: • To describe our endoscopic management of adult women with vesicoureteral reflux (VUR) and associated outcomes.

Patients and methods: • We retrospectively identified 19 adult women who presented for the endoscopic treatment of VUR from November 2001 to January 2008. • Each patient was diagnosed with VUR by voiding cystourethrogram or nuclear cystourethrogram after an episode of pyelonephritis or recurrent urinary tract infections with renal scarring on ultrasound. • A dimercaptosuccinic acid renal scan was performed prior to treatment. All patients underwent endoscopic treatment with dextranomer/hyaluronic acid copolymer (Deflux). Patients with bilateral VUR received bilateral injections during the same procedure. • Follow-up imaging was obtained and success was strictly defined as no degree of VUR. Patients with residual VUR received repeat endoscopic treatment.

Results: • Nineteen patients with a mean age of 22 years old (range 18-33 years old) underwent endoscopic treatment for VUR. A total of 79% (15/19) had pre-existing risk factors for VUR, including prior open anti-reflux surgery (26%), family history of VUR (26%) and childhood diagnosis of VUR (26%). • Imaging revealed that 47% (9/19) had renal scarring and 26% (5/19) had bilateral VUR. The success rate was 79% (19/24) after one treatment, 92% (22/24) after 5 patients received a second treatment, and 96% (23/24) after 2 patients received a third treatment. There were no perioperative complications.

Conclusion: • Endoscopic management of VUR is both safe and effective in adult women.

MeSH terms

  • Adolescent
  • Adult
  • Cystoscopy / methods*
  • Dextrans / therapeutic use*
  • Epidemiologic Methods
  • Female
  • Humans
  • Hyaluronic Acid / therapeutic use*
  • Pyelonephritis / complications
  • Treatment Outcome
  • Ureteroscopy / methods*
  • Urinary Tract Infections / complications
  • Vesico-Ureteral Reflux / etiology
  • Vesico-Ureteral Reflux / surgery*
  • Young Adult

Substances

  • Dextrans
  • dextranomer-hyaluronic acid copolymer
  • Hyaluronic Acid