Subureteric polydimethylsiloxane injection in the treatment of vesico-ureteric reflux

Aim of the Study:Subureteral endoscopic injection of a bulking agent is an attractive alternative to open surgery or antibiotic prophylaxis for vesico ureteral reflux (VUR). Little information is available about long-term risk of recurrence after an initially successful treatment. Aim of this paper was to review short- and long-term success rate of endoscopic treatment in a single Center series after risk stratification of individual patients.Materials and Methods:The records of 126 patients who underwent Deflux injection for primary VUR were examined. Indications to treatment were an unvaried high grade VUR (IV-V) at 1 year from diagnosis and/or and recurrent urinary tract infection (UTI) on antibiotic prophylaxis even in the presence of mild grade VUR (III grade). Gender, age and mode of diagnosis, infections (UTI), voiding dysfunctions, VUR grade and side, renal function, number of treatments were correlated to outcome. Long-term evaluation was planned at a minimum of 1 year from the last negative post-injection cystogram (MCUG). A new MCUG and DMSA scan were also offered to those complaining new UTI episodes. Late recurrences were correlated to history and grade of reflux. Data were analyzed with Graph Pad Instat software; the Chi-square test was used for univariate comparisons, the Fisher's exact test for categorical variables.and multiple regression tests for factors influencing outcome.Results:M/F ratio was 62 to 64; median age at diagnosis was 28 months. VUR affected 198 renal units. Preinjection VUR grade was I in 1, II in 27, III in 107, IV in 59, and V in 4 units. Reduced DMSA uptake was evidenced in 51 units and scarring in 24. Median age at treatment was 34.5 months, for persistent high grade VUR (IV–V) in 55 patients and recurrent IVU in 92. Two hundred sixty seven injections were performed on 198 ureters. Complete resolution was documented by MCUG at 3-5 months in 68%, low grading < II in 20%, persistence or unsignificant reduction in 11%. Preoperative recurrent UTI, higher grade VUR, and bilaterality were correlated to a poorer surgical outcome. Among 80 successfully treated cases, 12 complained of persistent UTI. Recurrence of VUR was demonstrated in 31% of them. Deteriorated uptake or additional scarring in 25% was independent from VUR recurrence. Preoperative recurrent UTI and voiding dysfunction correlated significantly to late outcome.Conclusions:Preoperative recurrent IVU, together with high-grade reflux, seem to correlate to lower success rate of Deflux injection for primary VUR. Even after successful endoscopic treatment, long-term surveillance may be needed among these cases, mainly if voiding dysfunction is also recorded. Late recurring VUR must be actively excluded in case of new IVU episodes.

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“…[2930] Nowadays, Deflux and Macroplastique are the most frequently used bulking agents with a reported success rate between 68% and 90%. [3132]…”

Section: Discussionmentioning

confidence: 99%

Patients with a history of infection and voiding dysfunction are at risk for recurrence after successful endoscopic treatment of vesico ureteral reflux and deserve long-term follow up

Coletta¹,

Olivieri²,

Briganti³

et al. 2012

Urol Ann

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“…The use of injectable materials, e.g. polydimethylsiloxane (PDS) in the treatment of VUR in children has been reported [1,2]; reflux is also a common urological abnormality among patients with chronic renal failure (CRF) [3]. Because reflux is associated with recurrent UTI, it must be treated promptly before kidney transplantation.…”

Section: Indicationsmentioning

confidence: 99%

The use of solid‐state polydimethylsiloxane in the management of vesico‐ureteric reflux in patients with renal failure prepared for renal transplantation

2003

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“…Deflux represents a new biocompatible material without immunogenic properties and a lack of distant migration. Previous studies indicated high success rates of 68% to 90% with endoscopic injection using Macroplastique or Deflux [5-7]. …”

Section: Introductionmentioning

confidence: 99%

Endoscopic Subureteral Injection for the Treatment of Vesicoureteral Reflux in Children: Polydimethylsiloxane (Macroplastique®) versus Dextranomer/Hyaluronic Acid Copolymer (Deflux®)

Bae

Park

et al. 2010

Korean J Urol

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Purpose: The aim of this study was to compare cure rates and complications of polydimethylsiloxane (Macroplastique Ⓡ ) and dextranomer/hyaluronic acid copolymer (Deflux Ⓡ ) in the treatment of vesicoureteral reflux (VUR). Materials and Methods: From April 2001 to March 2008, 29 boys and 42 girls (total of 115 ureters) with a mean age of 6 years who had undergone endoscopic subureteral transurethral injection for VUR were enrolled. A single subureteral injection of Macroplastique was performed in 31 ureters in 23 children (group I; grade II: 4; grade III: 12; grade IV: 9; grade V: 6), and a single subureteral injection of Deflux was performed in 84 ureters in 48 children (group II; grade II: 24; grade III: 14; grade IV: 25; grade V: 21). Renal ultrasound was done 1 day after injection, and voiding cystourethrography (VCUG) was done at 3 months. Successful reflux correction was defined as absent or grade I reflux on follow-up VCUG. Results: No significant difference in success rates was observed between group I and group II [80.6% (25/31) vs. 78.6% (66/84), respectively, p＞0.05]. The following postoperative complications developed: ureteral obstruction in 2 ureters of group I and 3 ureters of group II, asymptomatic urinary tract infection in 3 patients of group I and 2 patients of group II, and bladder calcification by erosion or mucosal necrosis in 2 patients of group I. Conclusions: Despite differences in material properties, both Macroplastique and Deflux were safe for the treatment of children with VUR. Because of the risk of bladder mucosal necrosis and substantial decreases in volume after implantation, long-term follow-up is required.

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Subureteric polydimethylsiloxane injection in the treatment of vesico-ureteric reflux

Cited by 11 publications

References 4 publications

Patients with a history of infection and voiding dysfunction are at risk for recurrence after successful endoscopic treatment of vesico ureteral reflux and deserve long-term follow up

Patients with a history of infection and voiding dysfunction are at risk for recurrence after successful endoscopic treatment of vesico ureteral reflux and deserve long-term follow up

The use of solid‐state polydimethylsiloxane in the management of vesico‐ureteric reflux in patients with renal failure prepared for renal transplantation

Endoscopic Subureteral Injection for the Treatment of Vesicoureteral Reflux in Children: Polydimethylsiloxane (Macroplastique®) versus Dextranomer/Hyaluronic Acid Copolymer (Deflux®)

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