Endoscopic Treatment of Vesicoureteral Reflux with Polydimethylsiloxane in Adult Women

Choo, Myung‐Soo; Hong, Bumsik; Ji, Young Hwan; Chung, Hyun Sung; Choe, Jun Ho; Park, ﻿Won Hee; Park, Taehan; Lee, Kyu‐Sung

doi:10.1016/j.eururo.2003.11.025

Cited by 17 publications

(21 citation statements)

References 11 publications

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“…In previous studies of adults with reflux, the amount of material injected ranged from 1.0 to 4.0 ml, which is somewhat more than in children [8,10,13,17] . In our experience, subureteral injection was technically difficult in adults, and the CAU were common (30.18%).…”

Section: Discussionmentioning

confidence: 99%

“…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] . Wadie et al [8] used polydimethylsiloxane with the endoscopic treatment and reported a 90% success rate in 20 ureters after a second injection in patients with renal failure who were prepared for renal transplantation.…”

Section: Discussionmentioning

confidence: 99%

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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%

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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“…Understandably, this can widen the circle of patients treated with bulking agents to include also adults. However, in oppose to increasing reports regarding using this technique in the pediatric age group, the reported experience in adults with Deflux is very limited [19, 29, 33]. Those reports usually describe the outcome of injection of various substances in series composed of mixed populations, including children and adults.…”

Section: The Evolvement Of the Therapeutic Approach In Adultsmentioning

confidence: 99%

Has the Data Efflux Regarding the Promising Outcome Following Injection of Deflux Changed the Management of Adult Vesicoureteral Reflux?

Zilberman

Mor

2008

Advances in Urology

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Primary vesicoureteral reflux (VUR), traditionally considered a problem of childhood, can also be detected during adulthood. However, while the concept regarding the therapeutic management of VUR in children has undergone revolutionary changes, moving from surgical to conservative approach, the optimal therapeutic approach in adult reflux is poorly addressed and is still unknown. Herein, we review clinical and therapeutic approaches of VUR in pediatric population as published throughout the years. With the introduction of Deflux injection as a minimally invasive procedure, we identify a beginning of a new trend that further extends the indications for endoscopic injections, including its introduction to adult patients as well.

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“…Studies suggest that ESI may also serve as a primary treatment for VUR in adults. 2,3 However, the experience with ESI in adults with VUR and decreased bladder compliance (D-BC) is limited.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of endoscopic subureteral injection for vesicoureteral reflux in adults with decreased bladder compliance

Lee¹,

Han²,

Jeong³

et al. 2010

Int J of Urology

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Objective: To evaluate the outcome of endoscopic subureteral injection (ESI) in adults with vesicoureteral reflux (VUR) associated with decreased bladder compliance (D-BC). Methods: We retrospectively reviewed the medical records of 46 consecutive patients who underwent ESI for VUR at a single tertiary academic center. Fourteen patients (17 ureter units) who had underlying neurological disease with decreased bladder compliance, as determined by filling cystometry, were grouped as D-BC. Thirty-two patients (47 units) who had no signs or symptoms that suggested neurogenic lower urinary tract dysfunctions were grouped as normal bladder compliance (N-BC). We compared the cure rates for ESI between groups, defining cure as complete resolution of reflux on voiding cystourethrogram. Results: In 70.6% of the D-BC group and 70.2% of the N-BC group, VUR resolved completely after the first injection (P = 0.977). One failed unit of D-BC was cured after second ESI, and seven failed units of N-BC were cured after additional treatments (second ESI, two patients; ureteroneocystostomy, five patients). No additional treatments were applied to three units of D-BC or seven units of N-BC without symptoms. No complications related to the ESI were observed. Conclusions: The ESI was found to be effective in adults with VUR regardless of the bladder compliance. As a minimally invasive procedure with a favorable outcome, ESI may represent the first choice for treatment of VUR even in adults with D-BC.

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Endoscopic Treatment of Vesicoureteral Reflux with Polydimethylsiloxane in Adult Women

Cited by 17 publications

References 11 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?

Has the Data Efflux Regarding the Promising Outcome Following Injection of Deflux Changed the Management of Adult Vesicoureteral Reflux?

Efficacy of endoscopic subureteral injection for vesicoureteral reflux in adults with decreased bladder compliance

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