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Vesicoureteral reflux in children: endoscopic treatment
C C Schulman1, D Pamart, M Hall
1Department of Urology and Radiology, Erasme University Hospital, Belgium.
Insights
Endoscopic correction of vesicoureteral reflux (VUR) in children using Teflon injections shows high success rates. However, concerns about Teflon particle safety and potential migration necessitate research into alternative, safer materials for VUR treatment.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Biomaterials Science
Background:
- Vesicoureteral reflux (VUR) in children is a common condition requiring effective treatment.
- Endoscopic correction of VUR has emerged as a popular minimally invasive alternative to traditional surgery.
- Teflon injection has been widely used for endoscopic VUR correction, with generally positive outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of endoscopic Teflon injection for VUR correction in children.
- To assess the long-term outcomes and potential complications associated with Teflon particles.
- To identify the need for alternative injectable materials for VUR treatment.
Main Methods:
- A retrospective analysis of 152 children treated with endoscopic Teflon injection for VUR over a 4-year period.
- Follow-up ranged from 3 months to 5 years, assessing success rates after one or two injections.
- Pathological examination of ureteral reimplantation specimens from 7 children to investigate Teflon-related reactions.
Main Results:
- Successful VUR correction was observed in 87% of primary reflux cases after one injection, and 93% after a second.
- For duplex systems, success rates were 58% after one injection and 74% after a second.
- Pathological studies revealed granulomatous reactions, with Teflon particles found outside the bladder in one case, but no long-term morbidity was observed.
Conclusions:
- Endoscopic Teflon injection is an effective treatment for pediatric VUR, offering high success rates.
- While Teflon has shown a good safety profile in the short-to-medium term, concerns regarding foreign-body reactions and particle migration persist.
- Development of an ideal, patient-derived injectable substance is crucial for safer and simpler VUR correction in children.
Abstract:
Endoscopic correction of vesicoureteral reflux in children has been increasingly used in the last years with encouraging results. During a 4-year period 152 children were treated by endoscopic injection of Teflon. A follow-up, ranging from 3 months to 5 years, was available for 173 refluxing ureters. For primary reflux, correction was observed after a single injection in 87% of the cases and in 93% after a second injection in some failures. In duplication, the technique is somewhat more difficult but the results quite satisfactory with 58% success after one injection, increasing to 74% after a second injection. The limitations of these techniques are underlined, the major concern being the safety of the injectable Teflon particles, eliciting a foreign-body granulomatous reaction with the potential hazard of distant migration. So far no long-term morbidity and complications have been observed with the use of Teflon to correct reflux. Extensive pathological study in 7 children submitted to ureteral reimplantation for failure of endoscopic correction showed a typical encapsulated granulomatous reaction below the intramural ureter, but particles of Teflon were noted in only one hypogastric ganglion when the Teflon was injected outside of the bladder. There is a need for finding an ideal substance for endoscopic injection, preferably prepared from the patient's own tissue allowing simple and safe correction of vesicoureteral reflux in children.