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Multicenter survey of endoscopic treatment of vesicoureteral reflux using polytetrafluoroethylene
1Children's Research Centre, Our Lady's Hospital for Sick Children, Dublin, Ireland.
Insights
Endoscopic subureteral polytetrafluoroethylene (Teflon) injection effectively treats pediatric vesicoureteral reflux in most cases. This safe, outpatient procedure demonstrates high success rates with minimal long-term complications.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Urologic Oncology
Background:
- Vesicoureteral reflux (VUR) is a common condition in children, increasing the risk of urinary tract infections and renal damage.
- Endoscopic subureteral injection offers a minimally invasive alternative to surgical correction for VUR.
Purpose of the Study:
- To evaluate the effectiveness, long-term outcomes, and safety of endoscopic subureteral polytetrafluoroethylene (Teflon) injection for treating pediatric VUR.
- To assess the success rates across different grades of VUR and analyze recurrence and complication rates.
Main Methods:
- A multicenter survey involving 53 pediatric urologists/surgeons from 41 centers worldwide.
- Data collected via questionnaires on 12,251 ureters in 1,921 boys and 6,411 girls treated between 1984 and 1996.
- Follow-up ranged from 1 to 13 years, with monitoring via voiding cystourethrography and renal ultrasound.
Main Results:
- Successful reflux resolution after one injection in 75.3% of ureters; overall success rate (including improvement) reached 81.3%.
- Failure to correct reflux occurred in 4.5% of cases, necessitating ureteral reimplantation.
- Vesicoureteral junction obstruction developed in only 0.33% of ureters; no adverse effects attributed to polytetrafluoroethylene were reported.
Conclusions:
- Endoscopic subureteral polytetrafluoroethylene injection is a simple, safe, and effective outpatient treatment for all grades of VUR in children.
- The procedure demonstrates a high success rate and favorable long-term safety profile, supporting its widespread use.
Purpose:
Endoscopic subureteral polytetrafluoroethylene (Teflon) injection has been used successfully to treat primary and secondary vesicoureteral reflux in children. We review the results of subureteral polytetrafluoroethylene injection in terms of its effectiveness, long-term followup and morbidity.
Materials And Methods:
A total of 53 pediatric urologists and/or pediatric surgeons at 41 centers worldwide answered an inquiry regarding experience with subureteral polytetrafluoroethylene injection in vesicoureteral reflux. Data were collected from a completed standard questionnaire. From 1984 to 1996, 1,921 boys and 6,411 girls with a mean age of 4.5 years (12,251 refluxing ureters) were treated endoscopically with subureteral polytetrafluoroethylene injection. Reflux was grades I to V in 407 (3.3%), 3,832 (31.2%), 5,213 (42.5%), 2,218 (18.1%) and 581 (4.7%) ureters, respectively. In the majority of patients subureteral polytetrafluoroethylene injection was performed on an outpatient basis. Most urologists monitored patients with voiding cystourethrography and renal ultrasound at 3 months, 1 year and 3 years. All patients were followed 1 to 13 years.
Results:
Reflux resolved in 9,226 ureters (75.3%) after 1 polytetrafluoroethylene injection, in 1,478 (12%) after 2 and in 250 (2%) after 3 or 4. Vesicoureteral reflux improved to grade I after 1 or 2 injections in 743 (6%) ureters, which needed no further treatment. Subureteral injection failed to correct reflux in 554 ureters (4.5%), which were then treated with ureteral reimplantation. Vesicoureteral junction obstruction requiring ureteral reimplantation developed in 41 ureters (0.33%). More than 90% of patients have been followed for more than 2 years. At followup reflux recurred in 326 (2.8%) endoscopically corrected refluxing ureters. No clinically untoward effects were reported in any patient due to the use of polytetrafluoroethylene as an injectable material.
Conclusions:
The results of this multicenter survey confirm that endoscopic subureteral polytetrafluoroethylene injection is a simple, safe and effective outpatient procedure for treating all grades of vesicoureteral reflux.