The endoscopic Treatment of high grade VUR


9th Annual Meeting of APAPU

Shanghai, China December 5-7, 2007



Ilhami surer, Gulhcine Military Medical Academy, Ankara, TurkeyObjectives

To evaluate the efficacy of subureteric injection with a bulking agent in patients with high grade primary VUR.


From January 2000 to October 2006, 94 children (161 ureters) were treated for high grade reflux by subureteric Dextranomer/HA injection or Positively Charged Dextranomer/HA injection endoscopically. The median age was 32 months (2 to 132 months). The procedure was administered on an outpatient basis. The follow-up evaluation consisted of a voiding cysto-urethrogram at 3 and 12 months after injection. The mean follow up was 32 (3-70 mo.) months.


After one injection, at the 3-months follow-up 92 of the 161 refluxing units resolved completely. Median injected volume was 1.4ml (0.7 - 1.6cc per ureteric aml). Overall success rate was 57.1% for all groups (74.2% in grade III, 44.4% in grade IV and 33.3% in grade V). After second and third injection in 19 re-refluxing units, overall success rate increased to 74,5% (87.1 in grade III, 53.7 in grade IV and 50% in grade V) at the I-year follow up. Slightly decreased success rates were achieved at 2-years follow-up program (Overall 70.8%). There was no complication related to the injection.


Endoscopic treatment of high grade reflux can be managed successfully in children. Also experience in the endoscopic procedures may be attributed on success and endoscopic treatment of high-grade VUR seems to be an alternative to other techniques and should be in the surgeon's armamentarium.