Endoscopic treatment of reflux by subureteric collagen injection: Critical review of 5 years' experience

In the past decade, subureteric endoscopic injection of Teflon or collagen has been propagated as a safe and successful treatment for vesicoureteral reflux, In our center, from 1990 through 1995, 118 children and 5 adults with reflux and recurrent urinary tract infections were injected with cross-linked bovine collagen in an open, prospective study, Efficacy and safety were assessed 6 and 12 months after injection, and long-term (greater than or equal to 3 years) results were available in 78 cases, The overall success rate was 58% (64% of ureteral units) free from reflux at 12 months and 54% (58%) after 3 years, Analysis of anatomic, urodynamic, and technical features showed the grade of reflux to be the best predictor of success or failure, When only primary low-and middle-grade reflux, without concomitant anatomic disorders, is considered, the long-term success rate rose to 69% (74% of ureteral units), In conclusion, subureteric collagen injection cannot ultimately replace the highly effective surgical reimplantation, However, the procedure offers a minimally invasive alternative in selected cases of mild reflux when conservative management is inadequate.