ENDOSCOPIC SUBURETERAL POLYDIMETHYLSILOXANE INJECTION IN THE TREATMENT OF PRIMARY REFLUX IN CHILDREN

Introduction: Research on endoscopic submucosal injection, as a less invasive treatment alternative of vesicoureteral reflux (VUR), and ideal injection material is still going on. The aim of this study is to analyze results of endoscopic polydimethylsiloxane injection in the treatment of primary VUR, and evaluate special features of this technique.

Materials and Methods: Between February 2000 and August 2002, a total of 24 children (total 36 reno-ureteral units) with primary VUR were treated with endoscopic injection of polydymethylsiloxane (Macroplastique®) into the ureterovesical junction of the refluxing ureters, and were enrolled to the study. Their mean age was 7.1±3.2 (range 1-12) years. Follow-up included voiding cysto-urethrography at 6 months after surgery and endoscopic re-treatment was offered if VUR persisted.

Results: The mean follow-up was 13.2±8.4 (range: 6-30) months. Initial polydymethylsiloxane injection resolved reflux in 36 ureters (69.4%). A second injection was successful in an additional 9 reno-ureteral units, resulting in an overall success rate of 86.1% (31 of 36 reno-ureteral units). The mean volume of polydymethylsiloxane injected per ureter in each session was 1.26 cc (0.5-2.6cc). Of 1 case with persisting VUR after 2 injections, 1 child, who experienced pylonephritis (4.1%), underwent open surgery. Extravasation of injected material, encountered in 1 case (4.1%), did not result in any complication, while a second injection successfully corrected the reflux in this child. De novo contralateral VUR (grade 2) developed in 1 child (4.1%), and she is under close follow-up. Evidence of distant polymethylsiloxane migration was not observed in any case.

Conclusion: Suburetral injection of polydimethylsiloxane may result in a success rate up to 90% in the endoscopic treatment of VUR, if injected correctly. As a minimal invasive, reproducible, safe and feasible technique, injection of polydimethylsiloxane seems to be an efficient alternative in the treatment of VUR.