Endoscopic management of vesicoueteral reflux in adult women

OBJECTIVE To describe our endoscopic management of adult women with vesicoureteral reflux (VUR) and associated outcomes. PATIENTS AND METHODS We retrospectively identified 19 adult women who presented for the endoscopic treatment of VUR from November 2001 to January 2008. Each patient was diagnosed with VUR by voiding cystourethrogram or nuclear cystourethrogram after an episode of pyelonephritis or recurrent urinary tract infections with renal scarring on ultrasound. A dimercaptosuccinic acid renal scan was performed prior to treatment. All patients underwent endoscopic treatment with dextranomer/hyaluronic acid copolymer (Deflux (R)). Patients with bilateral VUR received bilateral injections during the same procedure. Follow-up imaging was obtained and success was strictly defined as no degree of VUR. Patients with residual VUR received repeat endoscopic treatment. RESULTS Nineteen patients with a mean age of 22 years old (range 18-33 years old) underwent endoscopic treatment for VUR. A total of 79% (15/19) had pre-existing risk factors for VUR, including prior open anti-reflux surgery (26%), family history of VUR (26%) and childhood diagnosis of VUR (26%). Imaging revealed that 47% (9/19) had renal scarring and 26% (5/19) had bilateral VUR. The success rate was 79% (19/24) after one treatment, 92% (22/24) after 5 patients received a second treatment, and 96% (23/24) after 2 patients received a third treatment. There were no perioperative complications. CONCLUSION Endoscopic management of VUR is both safe and effective in adult women.