Evaluation of endoscopic treatment results of vesicoureteral reflux in adult patients

Introduction: In this study, it is aimed to evaluate the treatment results of adult patients who were operated endoscopically for vesicoureteral reflux (VUR). Method: Patients aged 18 and over who underwent endoscopic intervention for VUR between February 2014 and January 2020 were retrospectively evaluated. The patients were divided into 3 groups due to differences in VUR type and surgical intervention indications: 1. Patients with primary VUR with recurrent UTI or pyelonephritis sequelae on USG 2. Renal transplant candidates with VUR to the native kidney 3. Patients with VUR to a transplanted kidney Each patient with VUR was diagnosed by voiding cystourethrogram (VCUG). The results of bilateral cases were recorded individually for each ureter. Dextranomer / hyaluronic acid copolymer (DX-HA) was used as injection material in all patients. Scintigraphy and USG findings of the patients, history of febrile urinary tract infection, and the number of surgical procedures were recorded. Results: A total of 42 patients were enrolled. Thirty-eight of the patients were female (90.4%), 4 were male (9.5%), and the mean age was 35 (18-46) years. In the first group, as a result of the first injection of 31 ureteral units, the success rate was 62.5%, after the second procedure 42.8%, and the overall success rate was 71%. Regarding the rate of recurrent febrile urinary tract infection (UTI), an 85.7% improvement was noted in this group after the procedure. The average follow-up period for this group was 48 months. In renal transplant candidates with VUR to the native kidney, a total of 16 ureteral units were intervened. All patients were women. In this group, the success rate of the first and second injections was 56.2%, 40%, respectively, and the overall success rate was 68.7%. In the post-procedure imaging of 7 patients with VUR to the transplanted kidney, complete recovery was observed in 2 patients. Conclusion: Endoscopic DX-HA injection is an effective method in correcting VUR and healing recurrent febrile UTI and is well tolerated by adult patients. Endoscopic treatment can also be used safely in candidates for renal transplantation with VUR to native kidney and patients with VUR to transplanted kidney. Keywords: VUR, Recurrent febrile UTI, DX-HA, Endoscopic, VCUG