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Correction of vesicoureteral reflux in children by endoscopic collagen injection: a prospective study
1Department of Pediatric Surgery, Turku University Central Hospital, Finland.
Insights
Subureteral endoscopic collagen injection effectively corrects vesicoureteral reflux in children, with sustained success rates for simple ureters up to four years. This minimally invasive approach offers a viable treatment option for pediatric reflux.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Endourology
Background:
- Vesicoureteral reflux (VUR) is a common condition in children, increasing the risk of urinary tract infections and renal scarring.
- Endoscopic collagen injection offers a less invasive alternative to surgical correction of VUR.
Purpose of the Study:
- To evaluate the long-term efficacy and outcomes of subureteral submucosal endoscopic collagen injection for correcting VUR in pediatric patients.
- To assess the durability of reflux correction over a 4-year follow-up period.
Main Methods:
- A prospective study involving 148 children with 197 refluxing ureters (grades III-IV) treated with endoscopic collagen injection.
- Injections were performed under general anesthesia and repeated if necessary. Follow-up included radionuclide cystography and cystography at 1 month, 6 months, 2 years, and 4 years.
Main Results:
- Success rates for simple ureters (grades III-IV) were 93.9% at 1 month, decreasing to 81.8% at 4 years.
- Success rates for duplex ureters were significantly lower, with rates of 44.4% at 1 month and 21.4% at 4 years.
- Re-implantation surgery was successfully performed after failed collagen injections without complications.
Conclusions:
- Endoscopic collagen injection is an effective treatment for VUR, particularly in simple ureters with grade III reflux.
- The positive results for simple ureters appear stable beyond the 2-year follow-up mark.
- Collagen injection provides a valuable minimally invasive option for pediatric VUR management.
Purpose:
The aim of our prospective study was to evaluate the long-term results of correction of vesicoureteral reflux in children by subureteral submucosal endoscopic collagen injection.
Materials And Methods:
Between May 1988 and June 1994, 197 refluxing ureters in 148 children (grade III or IV, international grading system) were treated by collagen injection. Injection was done using general anesthesia and repeated 1 or 2 times if reflux persisted on the 1-month followup radionuclide cystogram. Cystography was repeated at 6 months, 2 years and 4 years.
Results:
After 1 month, 6 months, 2 years and 4 years grades III and IV reflux were cured in 93.9%, 91.7%, 85.3% and 81.8%, respectively, of 132 simple ureters. For the 27 duplex ureters success rates were 44.4%, 25.9%, 23.1% and 21.4%, respectively, after 1 month, 6 months, 2 years and 4 years. After failed injections neo-implantation was performed with no difficulty.
Conclusions:
Our results show that in simple ureters reflux, especially grade III, can be corrected by collagen injection. Results seem to be stable after 2 years of followup.