Endoscopic Treatment of Vesicoureteral Reflux in Patients With Myelodysplasia

Abstract

Purpose We assessed the usefulness of and indications for endoscopic treatment of vesicoureteral reflux in myelodysplasia patients. Materials and Methods A total of 26 patients treated with intermittent catheterization was divided into 11 (16 ureters) with and 15 without vesicoureteral reflux. In 9 patients (13 ureters) endoscopic correction was performed with 3 percent atelo-collagen and without anesthesia at the outpatient clinic. In each ureter we obtained the sum of scores for 4 risk factors for upper urinary tract deterioration: bladder compliance less than 10 ml./cm. water, grade 2 to 3 bladder deformity, detrusor-sphincter dyssynergia and urethral closure pressure 50 cm. water or greater. Results No reflux was demonstrated immediately after the initial collagen injection but cystography 3 to 6 months later showed recurrent reflux in 5 ureters (38 percent). Repeat injection cured the reflux, with results persisting for an average of 17 months. Mean risk factor score for patients without vesicoureteral reflux was significantly lower than that for patients with reflux. In patients treated with intermittent catheterization and anticholinergic agents the mean score for ureters with an increased or unchanged reflux grade was significantly greater than for those with a decreased grade. Conclusions Endoscopic treatment of reflux appears to be safe and useful in patients with myelodysplasia. This treatment is preferable in those with high risk factor scores due to the possibility of increased reflux grade in such patients.