Efficacy of Endoscopic Subureteral Polydimethylsiloxane Injection for Treatment of Vesicoureteral Reflux in Children: A North American Clinical Report

Herz, Daniel; Hafez, Ashraf T.; Bägli, Darius; Capolicchio, Gianpaolo; McLorie, Gordon A.; Khoury, Antoine E.

doi:10.1016/s0022-5347(05)65712-6

Cited by 73 publications

(52 citation statements)

References 24 publications

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“…The use of polydimethylsiloxane has been previously reported with a cure rate of 70-90% in children with VUR [11,12] . In a study of women, the subureteral injection of polydimethylsiloxane corrected the reflux in 37 of 43 ureters (86%) and the mean amount of polydimethylsiloxane was 1.5 ml [13] .…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Treatment of Vesicoureteral Reflux with Polydimethylsiloxane in Adults: Do Location and Appearance of the Ureteric Orifice Have a Role in the Success Rates?

Başok

Yıldırım²,

Atsu³

et al. 2008

Urol Int

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Introduction: Low success rate for high grade reflux and anatomical abnormality of ureteric orifices continues to be the most important dilemma of the endoscopic treatment of vesicoureteral reflux (VUR). The aim of this study was to evaluate the efficacy of endoscopic polydimethylsiloxane injection in adults with VUR concerning reflux severity and the status of the ureteric orifice. Materials and Methods: Fifty-three ureters (34 patients) were treated with endoscopic polydimethylsiloxane injection. The grade of VUR was I, II, III, IV and V in 2, 13, 25, 10 and 3 ureters, respectively.Any endoscopic characteristics of ‘golf hole’, broad appearance or lateral placement of ureteric orifices were classified as complex appearance ureters (CAU). Patients with persistent reflux were considered for second and third injections with the same material. Success was determined as no reflux. Results: The total success rate was 100, 92.30, 92, 80 and 66.66% for grade I, II, III, IV and V reflux after the third injection, respectively. The cure rates of ureters with normal appearance were 100, 88.88, 90, 100 and 100% for grade I, II, III, IV and V reflux. The cure rates of CAU were 100% for both grade II and III, 60% for grade IV and 50% for grade V reflux. The injected volumes per renal unit ranged between 0.2 and 3.2 ml (mean 1.05 ml). Conclusions: Although there are disadvantages in the usage of higher volumes of injectable material for successful results and difficulty in subureteral injection both in high grade reflux and complex anatomical situations in adults when compared to children, our results indicate that endoscopic treatment of VUR is an effective therapy for adults.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Treatment of Vesicoureteral Reflux with Polydimethylsiloxane in Adults: Do Location and Appearance of the Ureteric Orifice Have a Role in the Success Rates?

Başok

Yıldırım²,

Atsu³

et al. 2008

Urol Int

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“…Herz et al have shown an overall success rate of 81% after a single injection at an average followup of 18 months. 22 A review reported an overall success rate at one year, two years', and nine years' followup of 86-93%, 80-92%, and 77-100% respectively. 23 However, a specific gun for the injection of PDMS is needed to ensure high pressure during injection and it is technically more difficult to inject.…”

Section: Bulking Agentsmentioning

confidence: 99%

Vesicoureteral reflux: From prophylaxis to surgery

Blais¹,

Bolduc²,

Moore³

2017

CUAJ

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Vesicoureteral reflux (VUR) is one of the most common pathologies encountered in pediatric urology. Better understanding of the evolution of VUR and new endoscopic surgical techniques in the last decades have led to major changes in the management of this pathology. However, the treatment algorithm remains complex and is composed of a wide variety of options, from active surveillance to surgical treatment. Herein, we propose to review treatment options for VUR in order to help clinicians make the right treatment decision for the right patient.

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“…These endoscopic procedures are attractive because they are minimally invasive and it is anticipated that they will decrease patient discomfort, surgery extent, and operating time. [1][2][3][4][5][6] Several injectable bulking agents, such as polytetrafluoroethylene (PTFE) paste, 7,8 collagen gel, 9 -12 liquid or particulated silicone, [13][14][15][16] polymethylmethacrylate (PMMA) microspheres, [17][18][19] and autologous fat, 20,21 have been developed and applied in the injection therapies. However, concerns regarding the side effects of these materials have limited general acceptance of their usage.…”

Section: Introductionmentioning

confidence: 99%

The effect of microsphere degradation rate on the efficacy of polymeric microspheres as bulking agents: An 18‐month follow‐up study

et al. 2006

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The injection of bulking substances has been proposed as a new therapy to treat urinary incontinence and vesicoureteral reflux. Our previous study demonstrated that poly(lacticco-glycolic acid) (PLGA) microspheres have the potential to serve as a bulking agent for urological injection therapies. Hybrid tissues exhibiting a bulking effect were formed in vivo by PLGA microsphere injection, but long-term volume stability was not proven. In this study, we hypothesized that the biodegradation rate of the bulking substance (polymer microspheres) would affect the duration of volume conservation of the induced hybrid tissue. To test this hypothesis, rapidly degrading 75:25 PLGA microspheres and slowly degrading poly(L-lactic acid) (PLLA) microspheres were used as injectable bulking agents for the injection therapy. In vitro degradation tests showed that the mass losses of PLLA and PLGA were 16 and 96% of the initial masses, respectively, at 30 weeks. PLLA and PLGA microspheres were injected into the subcutaneous dorsum of mice. Both types of microspheres were easily injectable through 24-gauge needles. Histological examinations at various time points indicated that host cells from the surrounding tissues migrated to the spaces between both types of injected microspheres and formed new hybrid tissue structures. Lymphocyte migration was noted around the implanted PLGA and PLLA microspheres, but the inflammatory reaction diminished with time. Importantly, the volume of the PLLA hybrid tissues slowly decreased to 52% of the initial volume at 12 months and maintained that volume until 18 months, whereas the volume of the PLGA hybrid tissues rapidly decreased to 22% at 6 months, and the PLGA hybrid tissues disappeared at 11 months. These results show that the biodegradation rate of the bulking substance may be useful for controlling the duration of volume conservation of the induced hybrid tissue.

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Efficacy of Endoscopic Subureteral Polydimethylsiloxane Injection for Treatment of Vesicoureteral Reflux in Children: A North American Clinical Report

Cited by 73 publications

References 24 publications

Endoscopic Treatment of Vesicoureteral Reflux with Polydimethylsiloxane in Adults: Do Location and Appearance of the Ureteric Orifice Have a Role in the Success Rates?

Endoscopic Treatment of Vesicoureteral Reflux with Polydimethylsiloxane in Adults: Do Location and Appearance of the Ureteric Orifice Have a Role in the Success Rates?

Vesicoureteral reflux: From prophylaxis to surgery

The effect of microsphere degradation rate on the efficacy of polymeric microspheres as bulking agents: An 18‐month follow‐up study

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