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Endoscopic collagen injection: its limits in correcting vesico-ureteral reflux in duplicated ureters
1Department of Pediatric Surgery, Turku University Central Hospital, Finland.
Insights
Endoscopic collagen injection is largely ineffective for treating vesicoureteral reflux in children with duplicated ureter systems. Most children required further surgical intervention, highlighting limitations in this minimally invasive approach for complex reflux cases.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Urological Conditions
Background:
- Vesicoureteral reflux (VUR) is a common condition in children.
- Reflux into a totally duplicated ureter system presents unique anatomical challenges.
- Current treatment options aim to prevent urinary tract infections and renal damage.
Purpose of the Study:
- To evaluate the efficacy of endoscopic collagen injection for treating VUR in children with totally duplicated ureter systems.
- To determine the long-term success rates of this minimally invasive procedure.
Main Methods:
- A prospective study involving 24 children with grade III or IV VUR in duplicated ureters.
- Submucosal injection of collagen (0.2-1.5 ml) via pediatric cystoscope.
- Follow-up using direct radionuclide cystography at 1 month, 6 months, 2 years, and 4 years.
Main Results:
- Only 11 of 24 children were initially reflux-free; success rates declined significantly over time (3/13 at 4 years).
- Success rates were significantly lower compared to children with single ureters.
- 83% of children (20/24) ultimately required operative intervention (Cohen procedure).
Conclusions:
- Endoscopic collagen injection is not a highly effective treatment for VUR in duplicated ureter systems.
- The anatomical complexity of duplicated ureters may limit the success of this endoscopic technique.
- Surgical intervention remains the primary treatment for many children with this condition.
Objective:
The aim of this prospective study was to investigate whether it is possible, by endoscopic collagen injection, to treat vesicoureteral reflux in children with reflux into a totally duplicated ureter system.
Methods:
For more than 7 years a prospective study has been in progress on children with grade III or IV reflux (international grading). Injections were made through a pediatric cytoscope, submucosally beneath the refluxing ureteral orifice. 0.2-1.5 ml collagen was injected. Reflux was controlled with direct radionuclide cystography 1 month later. Injections were repeated once or twice (within 3 months from the first injection) if reflux persisted. Additional controls with direct radionuclide cystography were made 6 months and 2 and 4 years later.
Results:
Up to now, 24 children (27 ureter units) with reflux to a totally duplicated ureter have been treated. After 1 month, 11 out of 24 children were free from reflux; after 6 months only 6 out of 24, after 2 years only 5 out of 23, and after 4 years only 3 out of 13 children were free from the disorder. There was no statistical difference between 1-month, 6-month, 2-year, and 4-year follow-up results. The differences among children with duplicated and single ureters at each control visit were statistically highly significant. There was no significant difference between results in grade III and IV reflux. We had to treat the reflux operatively (Cohen) in 20 of these 24 children (83%).
Conclusions:
Most of the children with reflux into a duplicated ureter system cannot be cured by endoscopic collagen injection.