Results of Treatment of Grades IV and V Vesicoureteral Reflux with Endoscopic Injection of Polyacrylate Polyalcohol Copolymer

Abstract

Purpose: Here we report the results of a review of a prospectively maintained database of the use polyacrylate polyalcohol copolymer (PPC) injection to correct grades IV and V VUR.Materials and Methods: All children with grades IV and V primary VUR that presented with febrile urinary tract infection while on prophylaxis, in a 3-year period, were treated with a sub-ureteral injection of PPC. Institutional ethical approval was obtained. Exclusion criteria were incomplete bladder emptying documented on videourodynamic study, ureteral duplication, paraureteral diverticula, and poor ureteral emptying observed during fluoroscopy and previous open surgical or endoscopic treatment. Pre- and post-operative evaluation included urinalysis, renal and bladder ultrasonography, DMSA scan, and videourodynamic studies.Results: Thirty-three children [36 renal units (RU)] were included with a median age of 57 months (range 7–108). There were 18 boys and 15 girls. Thirty RU had grade IV and 6 grade V VUR. Median follow-up time was 32 months (range 7–58). Reflux was cured in 32/36 RU with the first injection, but another two patients were reimplanted because of dilatation. Complications included early urinary tract infection in seven children, transient lower urinary tract symptoms in five children. Progressive ureteral dilatation was noted in four children and was treated with insertion of a double J stent. Two of these children eventually required an ureteroneocystostomy.Conclusion: The use of PPC to treat grades IV and V vesicoureteral reflux in young children has an overall success rate of 83.3%. Persistent ureteral dilatation was present in 11% associated with high injection volume. Future studies will attempt to maintain a high success rate reducing the volume of injection and the incidence of dilatation.

Endoscopic correction of vesicoureteral reflux in children using polyacrylate-polyalcohol copolymer (Vantris): 5-years of prospective follow-up

“…PPC is used successfully to treat primary reflux and also for complex cases [ 9 , 10 , 13 , 14 , 16 , 18 , 19 ]. The use of PPC to correct grades IV and V is also very efficient with an overall success rate achieved of over 80% [ 8 , 11 , 13 , 15 , 17 ].…”

“…Acute and delayed ureteral obstruction is also described after PPC 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 [ 2 , 4 , 5 , 8 , 11 – 16 ].…”

The Results of Endoscopic Treatment of Grade IV and V Persistent Vesiocoureteral Reflux in Children Using PolyacrylatePolyalcohol Copolymer (Vantris)

“…In 2010 Hunziker et al presenting 8-years experience with endoscopic correction of primary grade V reflux using Dx/HA (Deflux ®) (56 children, 63 RRUs) noted 52.4% success rate after single injection and downgrading to grade I in 11.1% whereas 30.2% of ureters required second and 6.3 % third injection to resolve VUR [9]. Recently published results with PPC (Vantris ®) to treat grade IV and V VUR showed significantly higher success rate as compared with Dx/HA (Deflux ®): 80-83,3 % resolution rate after single injection [10,11] or even 91.8% [12]. In 2013 we published our preliminary results: 13 RRUs grade IV VUR and 19 RRUs grade V with reflux resolution rate in 84.6 % and 89.5% of RRUs respectively after first injection and in 100% after repeated procedure [18].…”

“…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].…”

“…A limited number of reports regarding results and efficacy of endoscopic management of high grade reflux is still available. Various bulking agents were used for this purpose: polytetrafluoroethylene (PTFE) before 2000, dextranomer/hyaluronic acid copolymer (Dx/HA, Deflux ®) since 2000 and recently polyacrylate-polyalcoholcopolymer (PPC, Vantris ®) [4,5,6,7,8,9,10,11,12]. PPC (Vantris ®) a synthetic, non-absorbable tissueaugmenting substance was introduced into clinical practice in 2010 [13] and is currently used in some centers Around the world [14,15,16,17,18,19,20].The aim of the present study was to evaluate the efficacy of PPC injection to correct reflux grade IV and V in children.…”