Endoscopic Management of Vesicoureteral Reflux in Duplex Renal Collecting Systems

INTRODUCTION: Standardization of an optimal treatment protocol for vesicoureteral reflux (VUR) correlated with duplex kidney systems remains controversial. In this study, we reviewed our experience in endoscopic subureteric injection to correct reflux in duplex systems with documented indications, in an aim to confirm its position as an alternative means of open surgery.
METHODS: The hospital records of complete renal duplex system patients who had experienced endoscopic subureteric injection for VUR between 2009 and 2018 were reviewed. The indications for the amelioration of VUR included breakthrough urinary tract infection (UTI) along with the presence of renal scarring.
RESULTS: A total of 24 patients (18 girls, 6 boys) with refluxing renal duplex systems were included in the study. The mean age at first injection was 46.4±28.8 months (5-160) and the mean duration of follow-up was 47.25±27.7 months. The success rate with the initial injection was 83.3% (20/24). The mean volume of material injected was 0.68±0.49 ml per duplex system.
DISCUSSION AND CONCLUSION: Management of reflux in duplex systems is still controversial with insufficient data. Our results suggest that endoscopic management should be considered as an alternative to open ureteral reimplantation in refluxing renal collecting systems. Major open surgery and accompanying discomfort can be avoided by an endoscopic injection which can be performed as an outpatient procedure in most of the reflux patients with duplex system who have an indication for surgical management.