[Therapeutic options for primary vesicoureteral reflux: endoscopic vs open surgical approach]

Therapy of vesicoureteral reflux (VUR) has steadily changed during the last decade. Open surgical procedures, e.g. extravesical reflux repair with the Lich-Gregoir technique or ureterocystoneostomy with the psoas hitch technique, reference standards with excellent success rates, are less frequently used. Since its approval by the US Food and Drug Administration (FDA) endoscopic reflux therapy with Deflux® has gained more and more popularity. However, the usage of so-called bulking agents, e.g. Deflux®, still remains controversial in dilating reflux, while its application for low-grade VUR is increasingly being accepted. Despite higher recurrence rates in all grades of VUR, the use of the "minimally invasive injection" is increasing. The question has to be answered which therapy - if necessary - benefits the patient most. Which role has the subureteral injection gained and are open surgical procedures for VUR therapy "out"?