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Endoscopic treatment with polydimethylsiloxane in children with dilating vesico-ureteric reflux
Fabio Bartoli1, Francesco Niglio, Ottavio Gentile
1Cattedra di Chirurgia Pediatrica, Department of Surgical Science, University of Foggia, Via Luigi Pinto, 71100 Foggia, Italy. bartolifabio@libero.it
Insights
Injectable polydimethylsiloxane (MPQ) effectively treats pediatric dilating vesico-ureteric reflux (VUR). This minimally invasive treatment offers a high success rate for moderate to severe VUR, reducing the risk of kidney scarring.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Biomaterials in Medicine
Background:
- Moderate to severe dilating vesico-ureteric reflux (VUR) in children often persists with medical management, leading to renal scarring.
- Established treatments for VUR carry risks and may not always be effective.
- There is a need for safe and effective VUR treatments, particularly for severe cases.
Purpose of the Study:
- To evaluate the efficacy and safety of injectable polydimethylsiloxane (Macroplastique, MPQ) for treating pediatric dilating vesico-ureteric reflux (VUR).
- To assess MPQ as a potential alternative to surgical intervention for moderate to severe VUR.
Main Methods:
- A cohort of 32 children (40 ureters) with VUR grades III-V were treated with endoscopic MPQ injection.
- Patients with bladder dysfunction and associated diseases were included.
- Treatment was administered under general anesthesia using a cystoscope.
Main Results:
- Vesico-ureteric reflux (VUR) resolved in 80% of patients and improved in 20% after MPQ injection.
- Success rates were 72% after the first injection, 97% after the second, and 100% after the third.
- No significant complications were reported during the mean 28.5-month follow-up.
Conclusions:
- Endoscopic implantation of MPQ is a highly effective treatment for pediatric VUR, including severe grades (IV-V).
- MPQ offers a safe and successful minimally invasive option for VUR management.
- This technique should be considered a primary treatment option for severe VUR.
Objective:
To report our experience of treating dilating vesico-ureteric reflux (VUR) in children, using an injectable form of polydimethylsiloxane (Macroplastique, MPQ; Uroplasty BV, Geleen, The Netherlands), as medical treatment for moderate or severe VUR is associated with a high proportion of persistence or development of new scars.
Patients And Methods:
The study included 32 children (40 ureters) with VUR; 13 (32%) were grade III, 20 (50%) grade IV and seven (18%) grade V. They were treated over a period of 42 months, 66% for some form of bladder dysfunction and 38% had associated diseases. The main indications were VUR grade, recurrent urinary tract infection and progression of reflux nephropathy. MPQ was injected under general anaesthesia via an 11 F cystoscope, x 30 objective, with a 5 F working channel.
Results:
The mean (sd) follow-up was 28.5 (10.2) months; VUR resolved in 80% of patients and improved to minimal VUR in the remaining 20%. The resolution/improvement rate was 72% after the first injection, 97% after the second and 100% after the third. There were no significant complications.
Conclusion:
The endoscopic implantation of MPQ always corrected VUR even though 68% of the cases were grade IV-V. It should become the treatment of choice for severe VUR.
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