Deflux injections for vesicoureteral reflux in transplanted kidneys

Vesicoureteral reflux (VUR), a complication after kidney transplantation, may be caused by recurrent urinary tract infections evaluating in life-threatening pyelonephritis and urosepsis. Open surgical correction is the standard treatment despite its morbidity. However, minimally invasive approaches are available.

Our study group describes seven patients with functioning kidney grafts and a diagnosis of VUR associated with recurrent urinary tract infections. The procedure was performed under antibiotic prophylaxis and spinal anesthesia. An endoscopic injection of 1 mL of biomaterial (copolymer of dextranomer and hyalurunic acid) was administered into the ureteral neo-orifice following the Sting technique. The catheter was removed within 24 hours in all cases.

Between June 2009 and January 2010, nine procedures were performed in seven patients. Two patients experienced self-limiting post-surgical episodes of hematuria that did not need urologic manipulation. There were no episodes of retention, ureteral obstruction, or urinary infections. One patient required a reinjection 5 months later as a result of clinical failure. Apart from this one case, the other patients showed improvements with no infectious complications.

Endoscopic correction with VUR seems to be a reliable and safe option as a first treatment for the transplant patient. More cases are required in order to improve the learning curve and, therefore, the success rate. Closer monitoring is needed to evaluate the efficiency of the copolymer, the evolution of the reflux, and the possible long-term complications in this sort of patients.