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Subureteric Polytef injection in the management of vesico-ureteric reflux in children
Insights
Subureteric Polytef injection effectively treats vesico-ureteric reflux in children. This minimally invasive procedure offers a high success rate, with 90% of cases resolved after one or two injections.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Urologic Therapeutics
Background:
- Vesico-ureteric reflux (VUR) is a common condition in children.
- Subureteric Polytef injection presents an alternative management option for VUR.
- Open ureteric reimplantation is a traditional surgical approach for VUR.
Purpose of the Study:
- To prospectively evaluate the efficacy of subureteric Polytef injection for managing VUR in children.
- To determine the success rate and complication profile of this minimally invasive technique.
- To compare outcomes with traditional surgical methods.
Main Methods:
- Prospective study of 47 children (60 refluxing units) treated by a single surgeon over 2 years.
- Subureteric Polytef injection administered as the primary treatment.
- Follow-up cystograms to assess treatment success and grade of reflux.
- Repeat injections for treatment failures.
Main Results:
- Reflux was abolished in 82% of ureters after a single injection.
- A repeat injection increased the overall success rate to 90%.
- No cases of ureteric obstruction were reported; 10 ureters showed reduced reflux grade.
Conclusions:
- Subureteric Polytef injection is a viable and effective minimally invasive alternative to open ureteric reimplantation for pediatric VUR.
- The procedure demonstrates a high success rate with a favorable safety profile.
- Further management options exist for unresolved cases, including repeat injection or ureteric reimplantation.
Abstract:
Subureteric Polytef injection is one of the alternatives now available for the management of vesico-ureteric reflux in children. The results of the treatment by one surgeon, over a 2 year period, were studied prospectively in 47 children (60 refluxing units). Following a single injection, reflux was abolished in 49 (82%) ureters and of the 11 failures, 10 ureters showed a reduction of the grade of reflux while one remained unchanged. A repeat injection was performed in nine of these ureters with success in five, persistence in two, and two children are awaiting a follow-up cystogram. The conservative success, with the addition of a second injection, was 90% (54/60). Of the four with unresolved reflux, two have low grade reflux and are free of infection, and two have had a ureteric reimplant, one of which was after a single injection, at the request of the parents. There were no instances of ureteric obstruction. These results show a viable, minimally invasive alternative to open ureteric reimplantation in the management of vesico-ureteric reflux in children.