Endoscopic correction of the vesicoureteral reflux after ureteral reimplantation in children

. Vesicoureteral reflux (VUR) is seen in 2 - 60% of patients after ureteral reimplantation. The present study summarizes the experience of several centers where endoscopic correction of the postoperative reflux was done with bulking preparations. Material and methods. A retrospective study including 43 patients (24 boys and 19 girls) with reflux of grade III-IV after various transvesical and extravesical ureteral reimplantations for primary megaureter, reflux, or kidney transplantation was performed. Exclusion criteria were: neurogenic bladder, posterior urethral valve and ureterocele. Patients’ age varied from 9 months to 17 years (average 70.6 months). VUR was unilateral in 40 patients and bilateral in 3 patients: a total number of operated ureters was 46. The interval between ureter reimplantation and endoscopic surgery ranged from 3 months to 8 years (average 18.9 months). Different biodegradable and stable bulking preparations were used in the procedure. Results. VUR was successfully corrected in 19 ureters (41.3%) after a single injection. The repeated procedure was performed in 14 ureters in case of decreased reflux grade after the first injection. In 5 ureters (35.7%), the reflux resolved after the repeated procedure. With the two mentioned injections, the total effectiveness of endoscopic VUR correction was 52.2%. There were no any ureteral obstruction. The only statistically significant factor affecting the effectiveness of treatment was the reflux degree. The effectiveness level for reflux grade III was 68.2% and for reflux grade IV - 37.5%. Conclusion. Endoscopic correction prevents ureter reimplantation in half of patients with a high grade of postoperative vesicoureteral reflux.