Late Ureteral Obstruction After Endoscopic Treatment of Vesicoureteral Reflux With Polyacrylate Polyalcohol Copolymer

Şencan, Aydın; Yıldırım, Hülya Tosun; Özkan, Keramettin Uğur; Uçan, Başak; Karkıner, Aytaç; Hoşgör, Münevver

doi:10.1016/j.urology.2014.07.030

Cited by 19 publications

(11 citation statements)

References 6 publications

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“…Several studies reported successful short-term outcomes (88.6%–93.8% of resolution rate) with PPC, which are similar or even superior to Dx/HA [232425]. However, ureteral obstruction was more commonly seen in PPC group within several months or even years after injection [242526] and a recent animal study also revealed that PPC leaded severe fibrosis on injection site [27]. These results have raised a caution for ureteral obstruction after PPC injection and a long-term data should be followed.…”

Section: Materials For Endoscopic Injectionmentioning

confidence: 99%

Endoscopic injection therapy

Kim

Lee

2017

Investig Clin Urol

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Since the U.S. Food and Drug Administration approved dextranomer/hyaluronic acid copolymer (Deflux) for the treatment of vesicoureteral reflux, endoscopic injection therapy using Deflux has become a popular alternative to open surgery and continuous antibiotic prophylaxis. Endoscopic correction with Deflux is minimally invasive, well tolerated, and provides cure rates approaching those of open surgery (i.e., approximately 80% in several studies). However, in recent years a less stringent approach to evaluating urinary tract infections (UTIs) and concerns about long-term efficacy and complications associated with endoscopic injection have limited the use of this therapy. In addition, there is little evidence supporting the efficacy of endoscopic injection therapy in preventing UTIs and vesicoureteral reflux-related renal scarring. In this report, we reviewed the current literature regarding endoscopic injection therapy and provided an updated overview of this topic.

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Section: Materials For Endoscopic Injectionmentioning

confidence: 99%

Endoscopic injection therapy

Kim

Lee

2017

Investig Clin Urol

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“…For IV and V VURs, which represent more than 1/3 of cases, success might be achieved in almost 85-89% RRUs after the first injection and in up to 97% after the second treatment [8]. However, some troubling reports on high ratio of UVJ obstruction following PPC injection could not be brushed aside [5][6][7]. Some researchers were concerned with the possibility of silent obstruction following Vantris injection and potential of gradual UVJ obstruction without clinical symptoms even many years after endoscopic correction and with normal US examinations during the short period after PPC injection.…”

Section: Discussionmentioning

confidence: 99%

“…We have proved that the obstruction following endoscopic correction of VUR might occur shortly following endoscopic correction and not relates to the type of tissue-augmenting substance used for endoscopic correction, but rather to the anatomical features of UVJ [4]. Moreover, some have raised concern that UVJ obstruction following PPC injection could be silent and developed at a substantial period of time after reflux correction [6,9]. These authors have suggested that it might lead to the delay diagnosis of obstruction and finally to the irreversible loss of renal function.…”

Section: Introductionmentioning

confidence: 90%

“…Endoscopic correction of VUR utilizing polyacrylate polyalcohol bulking copolymer (PPC, ® Vantris, Promedon, Cordoba, Argentina) has demonstrated high efficacy during a long-term follow-up without VUR recurrence [1][2][3]. However, some have raised their concern with regard to the higher obstruction rate following PPC injection compared with other tissue-augmenting substance utilized in the endoscopic correction of VUR [4][5][6][7][8][9]. We have proved that the obstruction following endoscopic correction of VUR might occur shortly following endoscopic correction and not relates to the type of tissue-augmenting substance used for endoscopic correction, but rather to the anatomical features of UVJ [4].…”

Section: Introductionmentioning

confidence: 99%

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Incidence of UVJ obstruction during long-term follow-up after endoscopic correction of VUR utilizing polyacrylate polyalcohol copolymer (PPC)

et al. 2020

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Purpose We present a long-term follow-up of patients who underwent VUR correction with polyacrylate polyalcohol copolymer (PPC) injection with an emphasis on UVJ obstruction and urinary tract infection. Methods During 2009-2012, 157 children (106 girls and 51 boys) with mean age of 4.8 ± 2.8 years (mean ± SD) underwent endoscopic correction of VUR using PPC. VUR was unilateral in 74 patients and bilateral in 83, comprising 240 renal reflux units (RRU). Of these, primary VUR was present in 197 RRU (82.1%) and 43 (17.9%) were complex cases. Median followup was 7 years (range 6-10 years). Average volume of PPC was 1.2 ml (range 0.6-1.8 ml) Results Reflux was corrected in 222 RRU (92.5%) after a single injection, and in 10 RRU (4.2%) after the second injection. In RRU 7 (2.9%), reflux downgraded to Grade I and II, and they were taken off antibiotic prophylaxis. One patient (0.4%) failed endoscopic correction and required ureteral reimplantation (UR). 11 (4.6%) RRU developed UVJ obstruction, of which 9 (3.8%) required UR. All patients developed obstruction between 1 and 2 years after injection. Nineteen (12.1%) patients developed low UTI, and 12 (7.6%) patients developed febrile UTI during follow-up. None of these patients demonstrated reflux recurrence. Conclusion Our data indicate that endoscopic correction utilizing PPC does not increase the risk of obstruction during long-term follow-up.

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“…Acute and delayed ureteral obstruction is also described after Vantris® injection and is estimated as the main postoperative complication. Early obstruction is managed expectantly, late is treated with insertion of the double J stent or requires open ureteroneocystostomy [10,13,15,20,23,24].…”

Section: Discussionmentioning

confidence: 99%