First-line endoscopic treatment effective in severe VUR

Atlanta-Endoscopic treatment should be a front-line therapy for the management of grade V vesicoureteral reflux, according to the authors of a retrospective study from the National Children's Hospital in Dublin, Ireland.

Endoscopic treatment of VUR involves injecting a bulking substance into the posterior wall muscle of the ureterovesical junction (UVJ) to compress the ureteral lumen, allowing the UVJ to function normally as a one-way valve. Endoscopic treatment has been traditionally used to treat less severe forms of VUR (grades II–IV), but that may be changing. The Children's Hospital Group, led by Prem Puri, MD, pediatric surgeon and director of research, reported positive results from its 21-year experience with endoscopic treatment of the most severe form of VUR. Findings were presented the American Academy of Pediatrics Section on Urology annual meeting.

Endoscopic treatment of grade V VUR was shown to be highly successful. After only one injection, VUR was completely resolved in 88 (53%) of 166 treated ureters. VUR resolved in an additional 21.7% after two injections and in an additional 6% after three injections. A smaller percentage of ureters, 15.7%, were downgraded to grade I or II VUR and required no further treatment. Only six (3.6%) of 166 ureters failed to respond to endoscopic treatment.

Procedure is well tolerated

Long-term impact of endoscopy was examined by annual renal and bladder ultrasounds for the first 3 years, then once every 2 years for a median of 12.2 years (range, 1-21 years). Urinary tract infections were reported in 13 (8.1%) of the 166 ureters; VUR recurrence was observed in nine ureters (5.4%). Five patients required ureteral reimplantation; one child underwent nephrectomy. All recurrences were within the first 3 years after treatment.

"Endoscopic treatment provides a high rate of success in the management of grade V vesicoureteral reflux in children," concluded first author Maria Men-ezes, MD. "The procedure should now be considered first-line treatment for this condition."

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