Investig Clin Urol.  2018 May;59(3):206-212. 10.4111/icu.2018.59.3.206.

New bulking agent for the treatment of vesicoureteral reflux: Polymethylmethacrylate/dextranomer

• Kim SW
• Lee YS
• Im YJ
• Han SW

• KMID: 2410595
• DOI: http://doi.org/10.4111/icu.2018.59.3.206

Abstract

PURPOSE
The aim of this study was to report preliminary results of endoscopic treatment of vesicoureteral reflux in children with a single injection of a new bulking agent, cross-linked dextran and polymethylmethacrylate mixture.
MATERIALS AND METHODS
We performed a single-center, single surgeon, prospective, off-label study using polymethylmethacrylate/dextranomer to treat vesicoureteral reflux. All patients underwent endoscopic injection, followed by renal ultrasound and voiding cystourethrogram at 3 months postoperatively to identify de novo or worsening hydronephrosis and vesicoureteral reflux correction (to Grade 0 or I).
RESULTS
Eighteen patients underwent injection of polymethylmethacrylate/dextranomer at our institution between April 2013 and December 2013. Ten were males and eight were females, with a median age of 58 months (range, 6 months to 5 years). Vesicoureteral reflux was unilateral in three patients and bilateral in 15, for a total of 33 renal refluxing units. Vesicoureteral reflux was Grade I in one renal refluxing unit, Grade II in 12, Grade III in 16, and Grade IV in four. Mean injected volume was 0.86 mL. Reflux was corrected in 23 renal refluxing units (69.7%) according to the 3-month voiding cystourethrogram. Complications included urinary retention in one patient. Mild pyelectasis was noted in one patient at 3 months, which spontaneously resolved 3 months later.
CONCLUSIONS
Our short-term data show that polymethylmethacrylate/dextranomer injection can be used to treat vesicoureteral reflux with comparable efficacy to other substances currently used and a low rate of complications. Long-term follow-up is required to confirm the usefulness of this material in treating vesicoureteral reflux.

Keyword

Endoscopy; Injections; Vesico-ureteral reflux

MeSH Terms

Child
Dextrans
Endoscopy
Female
Follow-Up Studies
Humans
Hydronephrosis
Male
Polymethyl Methacrylate
Prospective Studies
Pyelectasis
Ultrasonography
Urinary Retention
Vesico-Ureteral Reflux*
Dextrans
Polymethyl Methacrylate

Figure

• 

  Fig. 1 (A) preoperative cystoscopic finding, (B) competent ureteral orifice on the top of a “volcano” after injection of polymethylmethacrylate/dextranomer injection.

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