Investigation on unsuccessful endoscopic operation for cases with vesicoureteral reflux

Abstract

Endoscopic operation of vesicoureteral reflux (VUR) has several advantages such as less invasiveness and technical ease with the procedure and shorter hospitalization for the operation in comparison with coeliotomy, but the cure rate achieved by endoscopic operation compares unfavorably with that by coeliotomy. The unsuccessful cases of VUR by endoscopic operation were investigated to promote the success rate by endoscopic operation. Of 66 ureters in 55 patients 50 were successfully treated with the first operation, and 4 of 8 ureters with the second one. All 15 infants were cured, but the cure rate in females between 17 and 45 year old was significantly low (57%). An equally high cure rate was obtained by the endoscopic operation even in patients who had a high grade VUR, patulous ureteral orifices, an underlying neurogenic bladder, or episodes of urinary tract infection. All ureters were cured just after operation. The recurrence of VUR occurred in 19 ureters (29%) and 16 ureters were discovered at one month examination after operation, which indicates that olive oil dissolving teflon paste was partly absorbed to bladder tissue. Teflon paste shifted to internal urethral orifice in 4 unsuccessful ureters. Based on these findings, the endoscopic operation should be considered to be the preferred treatment among others in the management of VUR and the injection of sufficient volume of teflon paste into submucosal and muscular space of the bladder trigone could promote the cure rate.