Treating VUR

Endoscopic injection

What is it?

Endoscopic injection involves using an endoscope to facilitate the injection of material in or around the area where the ureter enters the bladder to repair the valve function and keep urine from refluxing back into the kidneys.

The child is put under general anesthesia. An instrument called an endoscope is inserted into the urethra up into the bladder. The endoscope has a tiny camera on its tip as well as a channel to allow the passage of a needle to make the injection. The surgeon guides the tip of the endoscope to the right spot and injects the material. The procedure takes about 20 minutes. 

What are the pros and cons of endoscopic injections?

Endoscopic treatment is used for VUR grades II through IV. The procedure is minimally invasive and does not require any incision.

The procedure is an outpatient treatment, so your child will usually go home that day. Additionally, there is usually no pain after the procedure. However, your child may experience stinging the first few times he or she urinates after the procedure as well as mild to moderate flank pain.

The success rate for endoscopic injection is high, but often not as high as open surgery. One study indicated that 68% of patients with VUR can expect to be cured with an endoscopic treatment. Subsequent studies have reported an improvement in the response rate, with cure achieved in 71% of patients or 86% of treated ureters after a single endoscopic treatment. Response rates were generally higher in children with lower grades of VUR.

While the risk of complications is significantly lower than surgery, there is the risk of infection and bleeding. And although it is a rare occurrence, the injected material might block the ureters, thus preventing urine from entering the bladder.

Since endoscopic treatment is less invasive than surgery many healthcare practitioners and parents feel more comfortable using it at an earlier stage to treat VUR than they would open surgery. This provides surgeons with a way to resolve VUR at an earlier stage and perhaps avoid prolonged antibiotic use and the stress of living with VUR on a daily basis.

Click here for information about the only FDA-approved material used for endoscopic injection.