Injection therapy: advancing the treatment of vesicoureteral reflux.

Vesicoureteral reflux (VUR) is a common urological anomaly among children, and is usually diagnosed following the occurrence of urinary tract infection(s). Treatment options are observation (non-treatment), antibiotic prophylaxis, ureteral reimplantation (open surgery) and endoscopic injection. The need for treatment of VUR is considered in light of the likelihood of spontaneous resolution and practical issues regarding management of the condition. The available evidence relating to the treatment options is reviewed alongside our experience in the clinic. Endoscopic injection, particularly when non-animal stabilized hyaluronic acid/dextranomer (NASHA/Dx) gel is used, has an excellent safety profile and fewer disadvantages than either open surgery or antibiotic prophylaxis. Post-treatment success rates approaching those with open surgery have been reported with NASHA/Dx gel. We conclude that endoscopic injection may be routinely recommended as a first-line treatment for VUR following a short period of antibiotic treatment.