Effect of Subureteral Injection of Polydimethylsiloxane in Women with Vesicoureteral Reflux

Ji, Young Hwan; Kim, Hong Sik; Choo, Myung Soo

Abstract

PURPOSE: Subureteral injection of bulking agents is an accepted, less invasive, treatment of vesicoureteral reflux (VUR) in children. Although this treatment modality is applied to adult patients with VUR, there have been few studies on polydimethylsiloxane (Macroplastique(R)) injection therapy for the treatment of VUR in women. We assessed the effectiveness of an endoscopic subureteral polydimethylsiloxane injection in adult women with primary VUR.
MATERIALS AND METHODS
18 patients (27 renal units), aged between 20 and 50 years were included in this study. The vesicoureteral reflux was grade I in 7, grade II in 13, and grade III in 7 renal units. Macroplastique(R) was injected submucosally under the ureteric orifice, converting the opening to allow the elevation of the mucosa, so that the orifices lay on the summit of a small mound, which assumed an elevated crescent appearance by the end of the procedure. The patients were followed up from 12 to 60 months (mean 29.2 months) with voiding cystourethrography.
RESULTS
Overall, the reflux was corrected in 23 of the renal units (85.2%), and in one other following a second injection. The correction rates, according to the reflux grade, were 100, 77 and 71% for grades I to III, respectively. There were no associated postoperative complications. The mean hospital stay and injected volume of one renal unit were 1.29 days (1-5 days) and 1.28cc (1.0-2.5cc), respectively.
CONCLUSIONS
Subureteral Macroplastique(R) injection therapy could be a primary treatment for low grade VUR in women because it is simple, less invasive, decreases hospital stay and shows a relatively high success rate.