*Purpose: Vesicoureteral reflux (VUR) in a kidney graft is a complication of post kidney transplantation (KT) causing recurrent upper urinary tract infection and consequent kidney dysfunction. Endoscopic injection therapy could be minimally invasive approaches to prevent the phenomenon.

*Methods: We analyzed KT recipients who underwent ureteroneocystostomy (UCS) at transplant, then underwent endoscopic injection of glutaraldehyde cross-linked (GAX) collagen (GC) or dextranomer/hyaluronic acid copolymer (Dx/HA ) for the treatment of VUR. The procedure was performed under spinal anesthesia, intravenous injection of indigocarmine (IC) was done to detect the ureteral orifice (UO), then materials were injected around UO (total 1-2ml). IC was injected intravenously to check the outflow of urine, success of VUR disappearance was confirmed by cystourethrography before finishing the operation.

*Results: GC injection was performed in 17 patient, 4male/13 female, duration of renal replacement therapy (RRT) before transplant was 2.25(0-22.5) years, post-transplant period was 2.7(0.5-8.9)years, 9 patient (52.9%) had febrile UTI, bladder capacity was 100 (40-350) ml. Follow-up period after endoscopic injection therapy was 12(0.75-16) years. GC failed in 13 of 17, then UCS was done as second treatment. Migration of collagen was detected in all 13 patients during UCS. Dx/HA injection was performed in 4 patient, all female, duration of RRT before transplant was 5.5(0-33.9) years, post-transplant period was 6.6(1.9-12.7)years, all patient had febrile UTI, their bladder capacity was 270 (170-300) ml. Follow-up period after endoscopic injection therapy was 4(2-6) months. Dx/HA failed in 1 patient after 3 months, reinjection of Dx/HA was done.

*Conclusions: Dx/HA provided better improvement due to stable implantation of injection material compared to GC, but longer follow up is required.

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