ORIGINAL ARTICLES   

Minerva Pediatrica 2000 January-February;52(1-2):7-14

Copyright © 1999 EDIZIONI MINERVA MEDICA

language: English, Italian

Long-term follow-up results of vesico-ureteral reflux treated with subureteral collagen injection (SCIN)

De Grazia E., Cimador M.

Background. Endoscopic subureteral injection is at the present a widely used technique for the treatment of vesico-ureteral reflux and it has a good range of efficacy, from 50% up to 90% in relation to different grades. In this paper we report our 1-7 year follow-up results of subureteral collagen injection (SCIN).
Methods. Between 1991 and 1997 we treated with SCIN 129 refluxing ureters in 93 children (60 females and 32 males), mean age 2.1 years (range 3 months-5 years). Fifty-five children had monolateral, but 37 had bilateral reflux. Distribution among different grades was 42 ureters (32.5%) grade 2, 63 (48.8%) grade 3, 24 (18.6%) grade 4. Children were treated with injection of highly purified bovine collagen. In this study all the children underwent radiological follow-up for evaluating the results of treatment with SCIN also in a period of time from 3 to 7 years after endoscopic procedure.
Results. After a 1 to 7 years follow-up period we have the following results. In grade 2 we have found absence of reflux in 36 cases (85.7%) after 1 injection and in 38 (90%) after 2 injections. In grade 3, reflux was absent on 46 cases (73%) after 1 injection and in 55 (87.3%) after 2 injections. In grade 4 reflux was cured in 16 (66.6%) after 1 injection and in 18 (75%) after 2 collagen injections, 15% of all units, underwent Cohen's reimplantation.
Conclusions. After 7 years of experience we have concluded that subureteral collagen injection is actually a very good procedure for treatment of mild grade refluxes. We treat these refluxing ureters only when antibiotics prophylaxis is to be prolonged over 6 months with no changes in cystourethrography findings or when recurrent urinary tract infections occur in spite of antiobiotics intake. In conclusion, if we evaluate the overall results we see that 73.6% of refluxing ureters have been cured by SCIN, the rate of recurrence is 16.8% and the 15.5% finally underwent Cohen's reimplantation.