Comparing clinical and radiological success in open versus endoscopic surgery of primary vesicoureteral reflux

To compare different forms of success in endoscopic urinary reflux treatment versus open surgery and factors associated with these results.

Retrospective analysis of patients with vesicoureteral reflux managed by endoscopic or open surgery from 2014 to 2019 were performed. Success was assessed in three distinct categories: Clinical success (CS), as the absence of any febrile urinary infection following treatment; relative radiological improvement (RRI), as reflux grade reduction in postoperative imaging; and absolute radiological resolution (ARR), as no reflux on postoperative imaging. The two surgical approaches are compared for each category of success; accounting for factors like age, sex, reflux grade, bilaterality, and bladder or bowel dysfunction (BBD).

448 patients comprising 743 reflux units underwent endoscopic (221 patients) and open surgery (227 patients). Overall CS rate is 88 % (95.2 % by open and 81 % by endoscopic) and overall ARR is 75.2 % (91.2 % by open and 58.8 % by endoscopic); open surgery significantly surpasses endoscopic in all categories of success (p = 0.0001). High grade reflux and bilaterality predicts lower ARR rate in endoscopic surgery. The presence of both bladder and bowel dysfunction reduces CS, regardless of surgical approach.

All three stated outcomes of reflux surgery are by far better achieved by open surgery than endoscopic means, but the latter still curbs febrile urinary infection in 81 % of patients. BBD is related with lower CS in both surgery groups while high grade reflux and bilaterality negatively affect the ARR rate only in endoscopic surgery. CS will often be sustained in the absence of ARR.