[Vesicorenal reflux following endoscopic treatment of vesical tumors. Developmental and therapeutic complications].

A survey of 107 patients treated for bladder papillomatosis, 78 of which recurred, confirmed the frequency of appearance of an iatrogenic reflux (28 cases: 26%). The main explanations for its onset are resection and orificial sclerosis. Two consequences of reflux are discussed. One is very probable: the development of tumoral lesions in the upper excretory pathways. Noted in 7 (25%) of the 28 cases, these high tumors can be partly explained by the mechanism of cell implantation, grafts being ascending in cases of reflux. A relation between severity of reflux and site of secondary tumor was not found (6 unilateral and 1 bilateral tumor). This was also true for the effect of the bladder lesion stage on frequency of high localizations. The second possible consequence of reflux, the subject of much greater debate, concerns the increased risk of toxicity from local chemotherapy which could lead to increase in the time and area of contact. This risk appears to be very low (2 interruptions of therapy in 10 patients treated with Thiotepa, none with mitomycin). Diagnosis of reflux affects treatment of the bladder tumor. When reflux is associated with high lesions, treatment of the tumor is the first imperative and is dependent on the manner in which it is conceived. When reflux is isolated, its surgical correction with the aim of preventing development of a pyelo-ureteral tumor is not widely accepted, since the condition of the patient and the course of the bladder disease must be taken into consideration.