Endoscopic treatment of vesicoureteral reflux in an adult population: Can we teach our adult urology colleagues?

Abstract

Objective: Vesicoureteral reflux (VUR) is not well described or understood in adults. Since endoscopic correction of VUR has become a first-line therapy in children, we aimed to evaluate the efficacy of this technique in adult patients.

Patients and methods: In 1988-2008, 49 adult patients (6 males, 43 females) with a mean age of 33.6 years (range 18-64) underwent endoscopic treatment of VUR. Reflux was unilateral in 17 (34.7%) and bilateral in 32 (65.3%) patients, comprising 81 renal refluxing units (RRU). Of these, 71 (87.7%) were primary VUR. Reflux was Grade I in 14 (17%), Grade II in 46 (56.8%), Grade III in 17 (21%) and Grade IV in 4 (4.9%) RRU. Median renal function at surgery was 41.2%. Endoscopic correction utilized polytetrafluoroethylene (Teflon) in 38 (77.6%) and dextranomer/hyaluronic acid copolymer in 11 (22.4%) patients. Recurrent febrile urinary tract infection (UTI) was the only indication for surgery. Grade I VUR was treated only in patients with contralateral high-grade VUR.

Results: The reflux was corrected in 63 (77.8%) RRU after a single injection, after second injection in 9 (10.6%) and after third in 4 (4.8%) RRU. In 3 (3.5%) RRU, VUR improved to Grade I. In 2 (2.4%), endoscopic correction failed, leading to open reimplantation. One patient with corrected VUR underwent nephrectomy due to non-functioning kidney and recurrent pyelonephritis. Fourteen (28.6%) patients suffered afebrile UTI. Five (10.2%) developed febrile UTI following successful endoscopic correction, leading to a diagnosis of VUR recurrence in two (4.1%) patients.

Conclusions: Endoscopic correction of VUR in adults is a simple and effective procedure, as in pediatric practice.