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Endoscopic correction of vesicoureteral reflux secondary to posterior urethral valves
1Children's Research Centre, Our Lady's Hospital for Sick Children, Dublin, Ireland.
Insights
Subureteral polytetrafluoroethylene (Teflon) injection effectively treats high-grade vesicoureteral reflux in children with posterior urethral valves. This endoscopic approach offers a simple, safe alternative to open surgery with high success rates.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Urologic Oncology
Background:
- Posterior urethral valves (PUV) are a common cause of bladder outlet obstruction in male infants.
- High-grade vesicoureteral reflux (VUR) is a frequent complication of PUV, leading to renal damage.
- Endoscopic management of VUR secondary to PUV is an area of active research.
Purpose of the Study:
- To evaluate the efficacy and safety of subureteral polytetrafluoroethylene (Teflon) injection for high-grade VUR in children with PUV.
- To compare endoscopic treatment outcomes with historical open surgical procedures.
- To assess the long-term success rates and potential complications of the injection technique.
Main Methods:
- Retrospective review of 15 children with high-grade VUR secondary to PUV treated with subureteral Teflon injection between 1985 and 1994.
- VUR was classified using the international grading system (grades IV and V).
- Follow-up included voiding cystography to assess reflux resolution and monitor for recurrence.
Main Results:
- Successful reflux elimination in 17 out of 24 ureters after a single injection.
- Additional injections were required in 7 ureters (5 with 2, 2 with 3 injections).
- No recurrence of reflux was observed during 1-10 years of follow-up; no adverse effects noted.
Conclusions:
- Subureteral polytetrafluoroethylene injection is a safe and effective endoscopic treatment for high-grade VUR in children with PUV.
- This minimally invasive technique provides a viable alternative to open antireflux surgery.
- The procedure demonstrates durable success rates and a favorable safety profile.
Purpose:
We review our experience with children with high grade vesicoureteral reflux secondary to posterior urethral valves treated endoscopically with subureteral polytetrafluoroethylene (Teflon) injection.
Materials And Methods:
Between 1985 and 1994, 54 infants and children were diagnosed with posterior urethral valves of whom 38 (70%) had vesicoureteral reflux. In 9 patients reflux resolved after valve ablation. Seven patients underwent nephroureterectomy for nonfunctioning kidneys and in 2 reflux was treated with continuous chemoprophylaxis. The remaining 20 patients underwent an antireflux procedure, including reimplantation of the ureters in 5 and subureteral polytetrafluoroethylene injection in 15. Of the 15 patients who underwent injection 6 had unilateral and 9 had bilateral vesicoureteral reflux. According to the international classification reflux was grade IV in 6 ureters and grade V in 18. Patient age at injection ranged from 8 months to 6 years (mean 2.2 years).
Results:
Reflux was eliminated in 17 ureters after a single subureteral polytetrafluoroethylene injection. Five ureters required 2 injections and 2 ureters required 3 to correct reflux. Followup of the 15 patients ranges from 1 to 10 years. Followup voiding cystography in the 15 patients (24 ureters) showed no evidence of recurrence of reflux. No clinically untoward effects were noted in these children from the use of polytetrafluoroethylene as an injectable material.
Conclusions:
Subureteral polytetrafluoroethylene injection is a simple and effective endoscopic alternative to open surgery for the management of high grade vesicoureteral reflux secondary to posterior urethral valves.