Endoscopic treatment of vesico-ureteral reflux: Experience of 99 ureteric moieties

AIMS: To study the outcome of endoscopic hyaluronic acid/dextranomer injection in patients with vesico-ureteric reflux (VUR). MATERIALS AND METHODS: Sixty-three children were evaluated with a median follow up of 18 months (12-55 months) before injecting hyaluronic acid/dextranomer in a total of 99 ureteric moieties. Median age at presentation was 24 months (6-72 months). Primary VUR was the main presenting diagnosis in 60%. Patients were monitored for urinary tract infection (UTI), glomerular filtration rate (GFR), renal scarring, persistence, or appearance of contra-lateral reflux. RESULTS: Grade III VUR was the most common (38%) followed by Grade IV (24%), Grade V (17%), Grade II (14%), and Grade I (7%). Most common cause for VUR was Primary (60%), followed by posterior urethral valve (PUV) (19%), bladder exstrophy (5%), anorectal malformation (ARM), epispadias, and duplex system. Analysis of patients characteristics at presentation revealed renal scarring (40%), split renal functions <35% (35%), recurrent UTI (15%), GFR <50 ml/min/1.73 m(2) (15%), serum creatinine >1.4 mg/dL (10%). Complete resolution (100%) of Grade I and Grade II VUR was achieved after single injection. For Grade III VUR, single injection resolved reflux in 85.5% ureters, 100% resolution was seen after 2(nd) injection. In Grade IV VUR, 1(st) injection resolved VUR in 83.3% ureters, 95.8% ureters were reflux free after 2(nd) injection, and 100% resolution was seen after 3(rd) injection. In Grade V VUR, 94% ureters showed absent reflux after three injections. CONCLUSION: Hyaluronic acid/dextranomer injection holds promise even in higher grades of VUR.