Unilateral vesicoureteral reflux: does endoscopic injection based on the cystoscopic appearance of the ureteral orifice decrease the incidence of de-novo contralateral reflux?

Journal Article (Journal Article)

OBJECTIVE: In patients with unilateral vesicoureteral reflux (VUR), it has been suggested that injection of a non-refluxing but cystoscopically abnormal contralateral ureteral orifice (UO) with dextranomer/hyaluronic acid (Dx/HA) should be performed to prevent the development of de-novo contralateral VUR. We evaluate the effectiveness of this practice. PATIENTS AND METHODS: Patients with primary unilateral VUR undergoing injection of Dx/HA from 2002 to 2005 at two institutions were eligible. Patients with unilateral VUR with cystoscopically abnormal contralateral UOs were injected with Dx/HA, while patients with normal appearing UOs received no treatment. Multivariate logistic regression models were used to estimate the impact of prophylactic injection on the development of de-novo contralateral VUR. RESULTS: In total, 101 patients with unilateral VUR and an abnormal appearing contralateral UO underwent prophylactic injection of Dx/HA while 45 patients with a normal appearing contralateral UO were untreated. In patients receiving prophylactic Dx/HA, 9% (9/101) of the previously non-refluxing ureters developed de-novo VUR. Similarly, 13% (6/45) of patients with a normal appearing UO treated by observation alone developed de-novo VUR (P=0.55). The overall incidence of 10% (15/146) de-novo contralateral VUR matches published results where this protocol was not followed. CONCLUSIONS: Our findings suggest that cystoscopic assessment and prophylactic treatment of an abnormal appearing, non-refluxing contralateral UO with Dx/HA is of little clinical benefit and should be abandoned.

Full Text

Duke Authors

Cited Authors

  • Routh, JC; Inman, BA; Ashley, RA; Vandersteen, DR; Reinberg, Y; Wolpert, JJ; Kramer, SA; Husmann, DA

Published Date

  • August 2008

Published In

Volume / Issue

  • 4 / 4

Start / End Page

  • 260 - 264

PubMed ID

  • 18644526

Electronic International Standard Serial Number (EISSN)

  • 1873-4898

Digital Object Identifier (DOI)

  • 10.1016/j.jpurol.2007.12.008


  • eng

Conference Location

  • England