Endoscopic injection for reflux

What is the procedure?

In vesicoureteral reflux (VUR), urine flows back from the bladder to the kidney. In endoscopic injection, a thin camera (cystoscope) is passed through the urethra into the bladder, and a special gel is injected under the spot where the ureter opens into the bladder. The gel “lifts” the ureteral opening, strengthens its valve function and prevents urine from flowing back.

Who is it for?

• low- and intermediate-grade (II–IV) reflux,
• recurrent infections despite antibiotic prophylaxis,
• families who do not want to continue prophylaxis for a long time,
• high-grade reflux in selected cases.

How is the procedure done?

• Under a short general anesthetic.
• There is no incision.
• It takes 15–30 minutes.
• The child usually goes home the same day.

Afterward

• There may be mild burning when passing urine for a few days.
• Normal life resumes in 1–2 days.
• A kidney ultrasound a few weeks later.
• If indicated, the result is checked 3 months later with a VCUG (voiding cystourethrogram).

Success and limitations

After one injection, success is about 70–90%, depending on the grade of reflux. If it does not work, the injection can be repeated. Over the long term, the reflux can come back. If there are bladder and bowel problems, they should be treated first; otherwise success is lower.

Open or robotic reimplantation has a success rate above 95%, but it is a bigger operation.