Il ruolo del trattamento endoscopico nella cura del reflusso vescico-ureterale. Esperienza di 16 anni

Aim. Vesico-ureteral reflux (VUR) is the most common urological malformation in pediatric age; nevertheless its optimal management remains controversial. Until early 80s, treatment guidelines for VUR recommended the use of antibiotic prophylaxis as initial therapy, with surgical repair for patients with persistent VUR. Endoscopic treatment of VUR has gained popularity and has proved successful in a high percentage of cases, but its role in the clinical practice remains to be established. Methods. In this paper, our series of 1029 patients and 1478 refluxing ureters, treated from January 1986 to June 2001, is presented. Reflux ranged from grade II to grade IV. In the first 14 cases Teflon was injected. After 1989 bovine collagen was used in 442 children and, since 1996, Deflux®, a nonallergenic, biodegradable dextranomer, in 573 cases. All patients were clinically evaluated for possible voiding dysfunctions. All patients completed a 12 month follow-up period. Results. After 1 or 2 injections, a voiding cystogram showed no VUR (or grade I) in 1123 ureters (76%). In grade II, III and IV success rates were, respectivily, 87%, 73% and 48%. Complications were minimal (0.5%). Conclusion. These results confirm that endoscopic treatment of VUR is a valid alternative to "open surgery" and to antibiotic prophylaxis. Failure of treatment is usually due to dislocation of the implanted material, secondary to voiding dysfunction. In conclusion, we recommend the endoscopic treatment in the majority of VUR, for the short hospital stay, the absence of significant complications and the high success rate. In grade IV VUR, the use of endoscopic treatment is still questionable. Patients with voiding dysfunction should be identified and treated with appropriate therapy prior to attempt an endoscopic treatment of VUR.