Endoscopic injection of bulking agents in pediatric vesicoureteral reflux: a narrative review of the literature

Abstract

In the last 20 years, endoscopic injection (EI) has affirmed as a valid alternative to open surgery for management of pediatric vesicoureteral reflux (VUR). This study aimed to investigate and discuss some debated aspects such as indications, bulking agents and comparison, techniques of injection and comparison, predictive factors of success, use in specific situations. EI is minimally invasive, well accepted by patients and families, with short learning curve and low-morbidity profile. It provides reflux resolution rates approaching those of open reimplantation, ranging from 69 to 100%. Obviously, the success rate may be influenced by several factors. Recently, it is adopted as first-line therapy also in high grade reflux or complex anatomy such as duplex, bladder diverticula, ectopic ureters. The two most used materials for injection are Deflux and Vantris. The first is absorbable, easier to inject, has lower risk of obstruction, but can lose efficacy over time. The second is non-absorbable, more difficult to inject, has higher risk of obstruction, but it is potentially more durable. The two main techniques are STING and HIT. To date, the ideal material and technique of injection has not yet clearly established, but the choice remains dependent on surgeon’s preference and experience.

Efficacy and safety of Hyadex for treatment of vesicoureteral reflux: a multicenter experience

“…The cause of the early obstructions reported in the literature may be the physical obstruction caused by the injected material. 13 Rossini et al 14 reported that VUR in children can predispose patients to febrile UTIs. Repeated UTIs can lead to renal scarring, hypertension, and ultimately end-stage renal disease.…”

Ureteral obstruction after endoscopic treatment of the vesicoureteral reflux in children

“…Ендоскопічну технологію можна вважати певною мірою альтернативою традиційній уретероцистонео стомії (УЦНС) з урахуванням її доволі високої ефективності, мінімальної травматичності, можливості повторних втручань та швидкої післяопераційної реабілітації дітей. Наводяться дані про 76% ефективність ліквідації МСР після однократної ін'єкції та 98% -після двократної [2,4,7]. З удосконаленням методик ширше застосовується корекція навіть IV-V ступенів МСР із використанням різних об'ємоутворювальних речовин [1,5].…”

Efficacy of Three Different Injection Techniques for the Endoscopic Treatment of Vesicoureteral Reflux (VUR) in Children: A Review of 10 Years of Experience

“…Thanks to its low invasiveness and morbidity, the cystoscopic injection of bulking agents has become a popular alternative for the treatment of VUR. 5 , 6 , 9–11 …”