Endoscopic treatment of vesicoureteral reflux in children with complete duplex and single system.

INTRODUCTION Vesico-ureteral reflux (VUR) is the most common pathology found in patients with complete duplex renal system (DS) and it shows lower tendency to spontaneous resolution when compared to single renal system (SS). Still nowadays the treatment of choice is open surgery with ureteric reimplantation. This is a retrospective study with the aim of compare efficacy of subureteric polydimethylsiloxane (Macroplastique ©) injection (SMING) in the management of VUR in DS and SS. MATHERIAL/METHODS Fifteen children (24 refluxing renal units) with VUR in DS underwent SMING. Ten children had monolateral VUR which was more frequent in lower moiety. VUR was graded intermediate/severe (III/IV-V grade) in 88% of renal units. Clinical history of urinary tract infections and bladder dysfunction was found in 40% of children. Indications for SMING were breakthrough urinary tract infections, severe or persistent VUR, development of new scars or deteriorating renal function. During follow-up patients underwent urinocolture, renal ultrasounds, micturating cystourethrography and Tc 99m DMSA renal scan. Antibiotic prophylaxis was continued until resolution of VUR or improvement to grade I. The outcome was compared with 44 children (60 refluxing renal units) with intermediate/severe VUR in SS. RESULTS VUR resolution/improvement rate was 88% in DS and 95% in SS. Ureteric reimplantation was necessary in 13% and 7% of DS and SS respectively. Transient ureteral obstruction was found in 1/15 and 5/44 patients. One child per group required double-J ureteric stent. Macroplastique © used was 1.2 ±0.5 cc in DS and 0.8 ±0.5 cc in SS (p<0.05). CONCLUSION We can say that SMING procedure is effective also in DS patients with intermediate/severe VUR. Success rate, number of procedures and complications are similar to SS group. The only difference was the mean amount of Macroplastique ©required, which was higher in DS.