[Critical evaluation of cystoscopy in pediatric vesico-ureteral reflux]

Authors report a study on endoscopical evaluation of 110 refluxing ureters in 65 children selected out of a group of 384 with VUR seen between 1977 and 1980. Cystoscopy was only undertaken either in patients with poor response to conservative treatment or in those with associated malformations. Radiologic-endoscopic correlation was rather good: 93% of grade II refluxing orifices were normally located or slightly lateralized, whereas 72% of grade III or IV were so. The length of submucosal tunnel was shorter than 5 mm in 68.75% of refluxing ureters. "Golf-hole" orifices were seen in 2/3 of the cases with grade III or IV reflux. Nevertheless, this correlation was poor in over one third of refluxing units because in these cases cystoscopic evaluation of ureterovesical junction enabled to modify (in either sense) indications for surgery made up only on clinico-radiologic grounds. Endoscopy for evaluation of VUR is justified in selected cases because of this incomplete correlation between radiological and anatomical findings.