Effect of Subureteral Injection of Polydimethylsiloxane (PDS) in Children with Vesicoureteral Reflux

Abstract

Subureteral injection of bulking agents is an accepted, less invasive, treatment of vesicoureteral reflux (VUR) in children. We evaluated the efficacy of an endoscopic subureteral polydimethylsiloxane (MacroplastiqueR) injection with primary VUR in children. A total of 21patients (31 renal units), aged between 2 and 15 years were included in this study. The vesicoureteral reflux was grade I in 5, grade II in 7, grade III in 9, grade IV in 7 and grade V in 3 renal units. PDS was injected submucosally under the ureteric orifice, converting the opening to allow the elevation of the mucosa, so that the orifices lay on the summit of a small mound, which assumed an elevated crescent appearance by the end of the procedure. The patients were followed up from 6 to 24 months (mean 18.5 months) with voiding cystourethrography. Overall, the reflux was corrected in 26 of the renal units (83.8%) in one injection. The correction rates, according to the reflux grade, were 100, 100, 88.8, 71.4, 66.7% for grades I to V, respectively. There were no associated postoperative complications. The mean hospital stay and operation time were 2.7 days (2∼4 days) and 17.5 minutes (12∼25 minutes), respectively. In conclusion, for low grade reflux, subureteral PDS injection therapy could be a primary treatment for VUR in children because it is simple, less invasive, decreased hospital stay and showes a high success rate.