An Experience of Endoscopic Polydimethylsiloxane Injection for the Treatment of Vesicoureteral Reflux in Children

Park, Jong Wook; Kim, Kwang Sae

Abstract

PURPOSE: We evaluated the efficacy of an endoscopic subureteral injection of polydimethylsiloxane (Macroplastique) for the correction of vesicoureteral reflux in children.
MATERIALS AND METHODS
The medical records of 15 children (19 refluxing ureters), who had undergone a single endoscopic subureteral injection of polydimethylsiloxane for the treatment of vesicoureteral reflux, were reviewed. After the injection, voiding cystourethrograms were performed after 3 to 10 months to evaluate the results. Renal and bladder ultrasonograms were taken after 3 to 30 months to check for the development of de novo hydroureteronephrosis and the presence of the implant at the bladder base. The follow-up duration was between 7 and 43 months.
RESULTS
Of the 15 patients, there were 6 boys and 9 girls, with ages ranging from 12 months to 14 years. The reflux was resolved in 10 of the 19 ureters, in 8 of the 15 children, after a single injection. The resolutions of reflux, by grade, were none in 2, 2 in 4, 5 in 7, 1 in 4 and 2 in 2 of the ureters of grade I to V, respectively. The unilateral reflux was resolved in 7 of the 12, the bilateral reflux in 2 (3 ureters) of the 3 and the reflux in a duplicated system in 1 of the 3 cases (2 ureters out of 4 ureters). In two cases with persistent reflux, ureteral reimplantations were performed due to repeated urinary tract infections and de novo upper pole ureteral refluxes. The remaining 5 cases with persistent reflux were observed with prophylactic antibiotics. Refluxes recurred in 2 of the ureters at 29 and 36 months after the injection, so chemoprophylaxis was restarted.
CONCLUSIONS
The single endoscopic subureteral polydimethylsiloxane injections resulted in a low success rate, but at a high cost. This procedure is considered inappropriate as a first line method for the correction of vesicoureteral reflux in children.