Long-Term (>10 Years) Results After Endoscopic Injection Therapy for Vesicoureteral Reflux

Endoscopic injection is an accepted alternative for the treatment of vesicoureteral reflux (VUR) with the most commonly used agent being dextranomer/hyaluronic acid (Dx/HA). There are few reports on very long-term results after this treatment, although the biodegradable nature of the product could indicate that results might deteriorate on the long term. We, therefore, decided to evaluate the efficacy of Dx/HA copolymer endoscopic injection, in terms of recurrence of febrile urinary tract infections (fUTIs) in children, with a follow-up of at least 10 years.

We analyzed the medical data of all children who were diagnosed with VUR and underwent endoscopic injection with >10 years follow-up, in two University Hospitals. We reviewed their medical files and then contacted patients by phone.

We found 68 patients who had undergone endoscopic treatment of VUR with a follow-up of minimum 10 years. We were able to contact 53 of these patients of whom 38 were girls, and 36 had bilateral VUR with a total of 89 ureteral units. Mean age at surgery was 86 months (26-136). Mean follow-up was 12.5 years (range: 10.5-15). No child presented postinjection obstruction. Thirteen patients presented with a recurrence of fUTI during the postoperative course of whom 8 presented persistent VUR. All recurrences of fUTI occurred within the first 5 years of follow-up. Four underwent a second injection and 4 underwent open reimplantation. Success rate per patient was 85%.

Results of endoscopic injection using Dx/HA remain stable over time (>10 years). In our series, recurrences of fUTI occur within the first 5 years of follow-up.