INTRODUCTION:

Although vesicoureteral reflux is described as a congenital malformation, it is increasingly frequent its iatrogenic origin, due to both surgical and radiotherapy treatments in men and women (1).
OBJECTIVES: Describe the profile of patients and the results of intravesical bulge injection (Bulkamid®) to correct vesicoureteral reflux (VUR).

A prospective study of 54 patients treated with Bulkamid® as a bulking agent injected with Urotech® needles to correct the VUR.
Groups according to the pathogenesis of VUR: G1: idiopathic, G2: associated with interstitial cystopathy, G3: associated with neurogenic bladder (NB), G4 associated with a history of pelvic radiotherapy (RT), G5: associated with a history of TBC.
Variables: Age, sex, BMI, initial symptoms (IS), laterality, procedure, results, secondary diagnoses (DDSS). Descriptive statistics, ANOVA, Student's t, Fisher's exact test, p <0.05 was considered significant.

Table. Older in patients with a history of RT and younger in NB.
Most frequent: IS: abdominal pain (44.44%), recurrent urinary tract infection (RUTI) (40.74%); left VUR (48.14%), bilateral (33.33%). Results of treatment: No worsening; They correct 48 patients (88.88%): 48.14% at 100%, 40.74% more than 50% of the reflux. Most frequent DDSS: arterial hypertension and depression. In women, in addition: RUTI, in men: a history of prostate cancer treated with surgery and RT.

The bulky substance Bulkamid® is very useful in the correction of vesicoureteral reflux of different etiologies, regardless of age, sex, history of radiation therapy or tuberculosis. We consider that correcting vesicoureteral reflux is essential to improve voiding dynamics, prevent decreased bladder capacity and impaired renal function associated with reflux, demonstrated in scientific literature (2-5).
Our study shows that in the follow-up of patients such as those with interstitial cystopathy o bladder pain syndrome, it is necessary to suspect de novo vesicoureteral reflux, and a voiding cystography must be performed in the case of suspicion. The same can be said for patients treated with radical prostatectomy with or without radiation therapy. Furthermore, it is the circumstance that in these patients, urinary incontinence occurs as an adverse effect of the treatment. Therefore, when it is intended to correct urinary incontinence and the patient has reflux, a greater complication can occur in the upper urinary tract, due to the lack of proper diagnosis and treatment of reflux, prior to correcting the incontinence.

In the case of the neurogenic bladder, in our study we cannot determine when reflux appears, while in patients with interstitial cystopathy or ulcerative painful bladder syndrome it appears in the advanced stages of the disease. In patients undergoing prostate cancer treatment, it appears as a consequence of treatment.

Patients with RUTI or nonspecific abdominal pain with a history of radiation therapy may present VUR. Bulkamid® provides high cure rates with a good safety profile.

María Fernanda Lorenzo Gómez and Juan Florencio Macias Núñez. Book: title: Nefrourología. Edit. MF Lorenzo Gómez©., 2013. ISBN 978-84-616603-2-2. Depósito legal: S-420-2013. Salamanca 2013, Spain.
Ricardo Gonzalez. Trastornos urológicos en los lactantes y niños. En: Behrman RE, Kliegman RM, Jenson HB. Nelson Text Book of Pediatrics.15 ed. Philadelphia: W.B.S Auroders Company; 2000. p. 625- 9.
Rushton H. Vesicoureteral Reflux and scarring. En: Martin Barrat T, Avner ED, Harmon WE. Pediatric Nephrology. 4 ed. Baltimore: Lippincott Willims and Wilkinss; 1999. p. 851-72.