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Is a secondary procedure necessary in every case of failed endoscopic treatment for vesicoureteral reflux?

 Hyun Jin Jung  ;  Young Jae Im  ;  Yong Seung Lee  ;  Myung Joo Kim  ;  Sang Won Han 
 KOREAN JOURNAL OF UROLOGY, Vol.56(5) : 398-404, 2015 
Journal Title
Issue Date
Child ; Child, Preschool ; Cystoscopy* ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Muscle, Smooth/physiopathology* ; Retrospective Studies ; Treatment Failure ; Treatment Outcome ; Urinary Bladder/physiopathology* ; Urodynamics* ; Vesico-Ureteral Reflux/therapy*
Child ; Endoscopy ; Urodynamics ; Vesico-ureteral reflu
PURPOSE: Endoscopic treatment (ET) has become a widely accepted procedure for treating vesicoureteral reflux (VUR). However, patients followed up after ET over long periods have reported persistent or recurrent VUR. We evaluated the natural course of failed ET in patients who required further treatments to help physicians in making decisions on the treatment of VUR. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients who were diagnosed with VUR and underwent ET from January 2006 to December 2009. A total of 165 patients with 260 ureters underwent ET. We compared the parameters of the patients according to ET success or failure and evaluated the natural course of the patients after ET failure. RESULTS: Mean VUR grade and positive photon defect were higher in the failed ET group than in the successful ET group. Six months after the operation, persistent or recurrent VUR was observed in 76 ureters (29.2%), and by 16.3 months after the operation, VUR resolution was observed in 18 ureters (23.7%). Twenty-five ureters (32.9%) without complications were observed conservatively. Involuntary detrusor contraction was found in 1 of 9 (11.1%) among the secondary ET success group, whereas in the secondary ET failure group, 4 of 6 (66.7%) had accompanying involuntary detrusor contraction. CONCLUSIONS: Patients in whom ET fails can be observed for spontaneous resolution of VUR unless they have febrile urinary tract infection or decreased renal function. Urodynamic study may be helpful in deciding whether a secondary procedure after ET failure is necessary.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Lee, Yong Seung(이용승) ORCID logo https://orcid.org/0000-0003-3778-9888
Im, Young Jae(임영재)
Han, Sang Won(한상원) ORCID logo https://orcid.org/0000-0003-0941-1300
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