Prognostic factors in the endoscopic treatment of vesicoureteral reflux.

Abstract

Objective: The role of endoscopic treatment in the management of vesicoureteral reflux (VUR) remains controversial. This study aims to identify the prognostic factors of endoscopic treatment success for VUR repair.

Material and methods: A retrospective, analytical study of patients -expressed as ureteral units (UU)- with endoscopically treated congenital VUR from 2000 to 2020 was carried out. Follow-up was maintained for 5 years after the last treatment, with clinical and radiological controls. Treatment success was defined as the absence of VUR at postoperative cystourethrography.

Results: 167 UUs were treated, 80% of which had high-grade VUR (III-V). Overall endoscopic treatment success was 92.8%. 90.9% of low-grade VUR cases were resolved in the first procedure. The poor prognosis factors identified included high-grade VUR (p= 0.02), early age at treatment (p= 0.001), and preoperative anteroposterior diameter of the renal pelvis (p= 0.001). 23% had other urological malformations; no statistical relationship as a poor prognosis factor was found (p= 0.08), but up to 45% required more than one treatment.

Conclusions: The endoscopic approach is effective for VUR treatment, especially in low-grade VUR cases. High-grade VUR and early age at surgery are poor prognosis factors. The association with other urological malformations does not reduce treatment success.