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Outcome of endoscopic treatment for vesicoureteral reflux in children using polydimethylsiloxane
Adel A Al-Hunayan1, Elijah O Kehinde, Mamdouh A Elsalam
1Department of Pediatric Surgery, Bin Sina Hospital, and Faculty of Medicine, Kuwait University, Safat, Kuwait.
Insights
Subureteral polydimethylsiloxane injection effectively treated vesicoureteral reflux in children, with 81.8% cured after one procedure. This minimally invasive endoscopic treatment offers a safe option for pediatric reflux management.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Biomaterials in Medicine
Background:
- Vesicoureteral reflux (VUR) is common in children, increasing risk of kidney infections and damage.
- Endoscopic treatment offers a less invasive alternative to surgery for VUR.
- Polydimethylsiloxane (PDMS) is a biocompatible material used as a bulking agent.
Purpose of the Study:
- To evaluate the efficacy and safety of subureteral polydimethylsiloxane injection for treating primary vesicoureteral reflux in children under 12.
- To assess the success rate of PDMS as a bulking agent in endoscopic VUR treatment.
Main Methods:
- A cohort of 40 children (59 ureters) with primary VUR (grades II-IV) underwent a single subureteral PDMS injection.
- Pre- and post-treatment evaluations included voiding cystourethrography, renal ultrasound, and DMSA scans.
- Follow-up averaged 26 months, with cure defined as absent VUR on cystourethrography at 2 months post-injection.
Main Results:
- A single PDMS injection successfully cured VUR in 81.8% of ureteral units (45/55).
- Improvement was noted in 9.1% (5/55), with no change in 9.1% (5/55).
- No recurrent reflux was observed in cured patients; one case of ureteral obstruction was managed surgically.
Conclusions:
- Endoscopic subureteral injection of polydimethylsiloxane is an effective and safe minimally invasive treatment for pediatric VUR.
- PDMS demonstrates good outcomes for grades II-IV primary VUR in children.
- This technique offers a viable, less invasive option for managing VUR in young patients.
Purpose:
We reviewed the outcome of subureteral injection of polydimethylsiloxane as a bulking agent for endoscopic treatment for vesicoureteral reflux in patients younger than 12 years.
Materials And Methods:
A total of 40 children (59 ureters) with primary grades II to IV vesicoureteral reflux were treated with a single subureteral injection from 1997 to 2001 and followed an average of 26 months (range 4 to 45). Results in 38 patients (55 ureteral units) were available for review. Each child underwent preoperative voiding cystourethrography, renal ultrasound, dimercapto-succinic acid scan and urine culture. Treatment was done on an outpatient basis. With the patient general anesthesia polydimethylsiloxane implant was injected transurethrally below the ureteral opening of the affected renal unit. Renal ultrasound at 1 week and voiding cystourethrography at 2 months were done to rule out obstruction at the injection site and/or persistent reflux, respectively. Cure was defined as absent vesicoureteral reflux on voiding cystourethrography 2 months after injection.
Results:
After a single injection polydimethylsiloxane cured vesicoureteral reflux in 45 ureteral units (81.8%), while in 5 (9.1%) the condition was improved. The remaining 5 ureteral units (9.1%) showed no change in reflux grade. In 1 patient (1.9%) with unilateral grade IV vesicoureteral reflux contralateral reflux developed. None of the cured patients had recurrent reflux during followup. In 1 patient ureteral obstruction was successfully treated with ureteral reimplantation.
Conclusions:
Endoscopic subureteral injection of polydimethylsiloxane implant in children with primary grades II to IV vesicoureteral reflux appears to be an effective, safe and minimally invasive technique.