Commentary to "Intermediate-long term follow-up indicates low risk of recurrence after double HIT endoscopic treatment for primary vesicoureteral reflux (VUR)".
The authors are to be commended for their ongoing commitment to reporting their extensive experience with endoscopic treatment of VUR using dextranomer-hyaluronic acid copolymer. They continue to set the standard for outcomes regarding endoscopic treatment. This most recent report demonstrates improved outcomes with a refinement in technique and the potential to obviate an invasive postoperative imaging study. If endoscopic treatment is utilized, the authors’ technique should be emulated and reported as well. The authors also report an interesting finding that there was a decrease in UTIs after endoscopic treatment. There remains a lack of consensus and even controversy regarding the diagnosis and management of VUR. Historically, recurrent pyelonephritis was considered an indication to treat VUR, but this has been called into question. The practice of prescribing daily antimicrobial prophylaxis has been extensively criticized. The authors and other investigators [1,2] have demonstrated a decrease in UTIs after endoscopic treatment of VUR. A natural, and reasonable, question is whether a minimally invasive, effective, short, outpatient procedure with minimal or no morbidity, such as endoscopic injection of a bulking agent, should be utilized to treat patients with VUR for the purpose of preventing new UTIs, including non-febrile infections. Undoubtedly,