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Updated: May 30, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Endoscopic treatment of vesicoureteral reflux: current practice and the need for multifactorial assessment
Göran Läckgren1, Arne Stenberg
1Section of Urology, Uppsala University Children's Hospital, S-751 85 Sweden.
Insights
Vesicoureteral reflux (VUR) in children is often treated with antibiotics or surgery. Minimally invasive endoscopic treatment offers high cure rates and is generally preferred over traditional methods for managing VUR.
Area of Science:
- Pediatric Urology
- Nephrology
Background:
- Vesicoureteral reflux (VUR) affects 1% of children, increasing UTI risk and potentially impairing renal function.
- Current management includes antibiotic prophylaxis (ineffective against UTI, promotes resistance) and open surgery (traumatic, risks complications).
Purpose of the Study:
- To evaluate endoscopic treatment with NASHA/Dx gel (Deflux®) as a preferred alternative for VUR management.
- To compare endoscopic treatment outcomes with open surgery and antibiotic prophylaxis.
- To explore a new VUR management approach considering multiple patient factors.
Main Methods:
- Review of studies on endoscopic treatment (NASHA/Dx gel) for VUR.
- Comparison of cure rates and complication profiles between endoscopic treatment, open surgery, and antibiotic prophylaxis.
- Discussion of non-treatment and individualized treatment strategies for VUR.
Main Results:
- Endoscopic treatment with NASHA/Dx gel demonstrates high cure rates (80-90%), comparable to open surgery.
- This minimally invasive approach is well-tolerated and effective even in complicated VUR cases.
- Open surgery is reserved for refractory cases (10-15%) or severe ureteral anomalies.
Conclusions:
- Endoscopic treatment is generally preferable to open surgery and long-term antibiotic prophylaxis for VUR.
- Individualized VUR management considering reflux grade, age, sex, renal scarring, and bladder dysfunction is proposed.
- Open surgery should be reserved for specific, non-responsive, or complex cases.
Abstract:
Vesicoureteral reflux (VUR) affects around 1% of all children. It carries an increased risk of febrile urinary-tract infections (UTIs) and is associated with impaired renal function. Antibiotic prophylaxis is an established approach to managing the condition, but it does not protect against UTI and encourages bacterial resistance. Ureteral re-implantation (open surgery) is a relatively traumatic procedure typically requiring hospitalization, and there is a risk of significant post-treatment complications. Endoscopic treatment with NASHA/Dx gel (Deflux®) is minimally invasive, well tolerated and provides cure rates approaching those of open surgery: 80-90% in several studies. It has also been shown to be effective in a variety of 'complicated' cases. Thus, endoscopic treatment is generally preferable to open surgery and long-term antibiotic prophylaxis. Non-treatment of VUR is being discussed as an alternative option, although this mainly appears suitable for children with low-grade reflux and normal kidneys. A new approach to managing VUR may be considered, with treatment decisions based not only on the grade of reflux but also on factors such as age, sex, renal scarring and bladder dysfunction. Open surgery would be reserved only for use in the 10-15% of children not responding to endoscopic treatment and those with severe ureteral anomalies.
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