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J Korean Med Assoc > Volume 51(11); 2008 > Article
Choi and Baek: Advances in Endoscopic Treatment of Children with Vesicoureteral Reflux

Abstract

Vesicoureteral reflux (VUR) is a common cause of urinary tract infection in children. The primary goals of managing VUR are to prevent pyelonephritis, renal damage, and long-term complications. Management may be either medical or surgical. The rationale of medical therapy is that spontaneous resolution of reflux often occurs with time. Surgical therapy is based on the principle that eliminating the reflux will minimize the likelihood of renal damage and other reflux related complications. Open ureteral reimplantation is 95~98% effective for correcting reflux, and has been the standard surgical treatment for many years. In recent years, the management of VUR has changed dramatically, mostly because of the widespread acceptance of endoscopic treatment. Optimal materials for endoscopic treatment need to be easy to inject, nontoxic, and not to migrate to other organs, result in minimal local inflammation, and be well encapsulated. Since the first clinical application of endoscopic treatment for VUR in 1984 employed subureteric polytetrafluoroethylene injection, the materials and techniques have improved considerably. Following the approval of dextranomer/hyaluronic acid by the U.S. Food and Drug Administration in 2001, the endoscopic treatment of VUR has become increasingly popular in many parts of the world. The combination of increased success, minimal morbidity, a reasonable safety profile, and short operative time has strengthened the role of endoscopic treatment for VUR. The long-term durability and reproducibility of results will make endoscopic treatment an effective alternative to antibiotic prophylaxis in low-grade reflux and to open surgery in high-grade reflux.

References

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Figure 1
International classification of vesicoureteral reflux (International Reflux Study Committee, 1981).
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Figure 2
(A) Percent change of reflux persistence, grades I, II and IV, for 1 to 5 years following presentation (B) Percent change of reflux persistence by age at presentation, grades III, for 1 to 5 years following presentation (The AUA pediatric vesicoureteral reflux clinical guidelines panel, 1997).
jkma-51-1051-g002-l.jpg
Figure 3
(A) Subureteric injection technique. (B) Hydrodistention-implantation technique.
jkma-51-1051-g003-l.jpg
Table 1
Various injection materials devoloped
jkma-51-1051-i001-l.jpg


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