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The effect of location of the ureteric orifice on the efficacy of endoscopic injection to correct vesico‐ureteric reflux
Author(s) -
Yucel Selcuk,
Ucar Murat,
Guntekin Erol,
Kukul Erdal,
Melikoglu Mustafa,
Baykara Mehmet
Publication year - 2005
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2005.05525.x
Subject(s) - medicine , reflux , vesicoureteral reflux , surgery , ureter , endoscopy , submucosa , cystoscopy , urology , endoscopic treatment , urinary system , disease
OBJECTIVE To review our 11‐year experience and identify the mechanisms responsible for the failure of endoscopic injection for vesico‐ureteric reflux (VUR) with three different injectable agents, based on the location of the ureteric orifice on endoscopy. PATIENTS AND METHODS We retrospectively reviewed the charts and endoscopic video‐photographs of 46 patients (26 girls, 20 boys, median age 6 years, range 2–16) with VUR treated once or twice by subureteric injection with PTFE, or polydimethylsiloxane or dextranomer/hyaluronic acid copolymer, from 1992 to 2003. Five patients were lost to follow‐up and six ectopic and/or duplicated ureters were excluded from the analysis; in all, 52 ureters were analysed. According to the international classification, the VUR was grades I to V in four (8%), 12 (23%), 16 (31%), 13 (25%) and seven (13%) ureters, respectively. RESULTS After 3 months, voiding cysto‐urethrography showed that VUR continued in six of 19, seven of 12 and eight of 21 ureters (38%), respectively, after subureteric PTFE, polydimethylsiloxane and dextranomer/hyaluronic acid copolymer injection; after the second injection, reflux continued in two of six, four of seven and three of eight ureters, respectively. Mound displacement and/or volume loss was the most common failure with all three bulking agents after both the first (62%) and second injections (44%) ( P < 0.05). The first injection failed in 32% (11 of 35) normally located ureters and 10 of 17 lateral ureters ( P < 0.05). The second injection failed in 11% (four of 35) normal and five of 17 lateral ureters ( P < 0.05). CONCLUSIONS A lateral ureteric orifice may decrease the efficacy of endoscopic injection, as the likelihood of a faulty injection is greater. However, a more careful second injection decreases the failure rate, particularly in those with low‐ to medium‐grade refluxing ureters.