Endoscopic treatment of vesicoureteral reflux with bovine collagen injections

Purpose: This study has been conducted to evaluate the long-term efficacy of subureteral glutaraldehyde cross-linked collagen injections for endoscopic treatment of vesicoureteral reflux (VUR). Methods: We prospectively studied 86 patients (mean age 8 years) with 128 refluxing ureteral units. All patients were treated with subureteral collagen injections and were followed up by voiding cystographies or videourodynamic evaluation. Results: 157 subureteral collagen injections have been performed on 128 ureteral units. This includes 27 second injections and 2 third injections. In 65 ureteral units a primary VUR was present, in 19 a secondary VUR.28 ureteral units presented with secondary reflux due to neurogenic bladder dysfunction. 7 ureteral units were treated with subureteral collagen injections after the VUR persisted following open surgical reimplantation, in 9 ureteral units a double ureter was present. After a follow up of 24 months a reflux recurrence was observed in 83% of ureteral units with primary VUR, in 56% of ureteral units with secondary VUR, in 85% of ureteral units with VUR due to neurogenic bladder dysfunction, in 67% of ureteral units of double ureters and in 34% of ureteral units after open surgical reimplantation. After a second injection and a follow up of 24 months 35% of patients remained reflex free. Conclusion: Our results suggest,that endoscopic subureteral bovine collagen injections remain ineffective in the long term follow up to correct VUR.