Management of vesicoureteral reflux: The comparison of the outcomes of ureteroneocystostomy and endoscopic subureteral injections

Abstract

Endoscopic subureteral injection has become an established alternative to ureteroneocystostomy in the treatment of vesicoureteral reflux. The outcomes of 61 patients with VUR whom treated with either ureteroneocystostomy or endoscopic procedures were compared. Ureteroneocystostomy was perfomed in 44 refluxing ureters of 31 children, subureteral Teflon injection in 34 refluxing ureters of 20, and Silicone injection in 17 refluxing ureters of 10 children. The ages, clinical, radiological, and endoscopic findings, operation time, hospital stay of the patients and outcomes of the treatments were compared. Ages of patients ranged between 1.5 and 17 (mean 6.7) years. There were grade II reflux in 23.5%, grade III reflux in 35.3% and grade IV reflux in 41.2% of the ureters of subureteral teflon injected patients. In subureteral Silicone injected patients these rates were 17.6%, 35.3% and 47.1%, respectively. Grade III, IV and V reflux also were found in 15.9%, 45.4%, 38.7% of the ureters of ureteroneocystostomized patients, respectively. In 70.5% and 88.2% of the ureters reflux was cured after the first and second Teflon injections. These rates were found as 53% and 76.4% after the first and the second Silicone injections, respectively. The reflux was cured completely in 95.45% of the ureters of the ureteroneocystostomized patients. Mean follow-up was 18.7 (ranged 5.5 to 41) months. Mean hospital stay was found as 1 and 12 days after the injections and ureteroneocystostomy, respectively. In conclusion, although ureteroneocystostomy is the gold standard treatment for high grade refluxes, endoscopic subureteral injections may be the first choice for the treatment of moderate grade refluxes because of its non-invasiveness.