Aim of the study: To define the guidelines of endoscopic treatment of vesico-ureteral reflux (VUR) in children in relation to grade of VUR, of the location of the ureteral orifice, of the stage of reflux nephropathy and of the association with other urinary tract malformations.
Materials and methods: 498 children with vesico-ureteral reflux (VUR) were observed in 702 ureters. All the patients were submitted to a complete urological evaluation and to endoscopic treatment (ET) of the VUR with the implant of a stable polyacrylamid gel (DAM+).
Results: The reflux was degree I in 53 ureters, II in 174, III in 301, IV in 165 and V in 9 ureters. VUR was primary in 149 children, secondary to a neurogenic dysfunction of the bladder in 271 patients, complex in the remaining cases. An overall 90.5% success rate of endoscopic treatment with "DAM+" implantation was observed. Success of VUR endoscopic treatment was obtained in 80% of cases with- orifice lateralisation, in 60% of cases with high and low intravesical orifice ectopy, and in 10% of cases with extravesical orifice. In 151 ureters (21.5%) endoscopical treatment of VUR had to be repeated, while a third procedure was necessary in 42 ureters (5.9% of cases). In total 895 endoscopic procedures were performed. Open surgical ureteral reimplantation was performed in the cases with persisting VUR after the third attempt of endoscopic procedure.
Conclusion: These results of the endoscopic treatment of VUR in children confirm the high efficacy and safety of this method. In any case, before choosing the method of VUR correction, it is necessary to inform the parents of the child about the potential rate of success of the endoscopic treatment in function of the peculiarity of the individual patient.