Endoscopic Correction of VUR Using Vantris as a New Non-biodegradable Tissue Augmenting Substance: Three Years of Prospective Follow-up

Abstract

To evaluate the efficacy of Vantris in children with vesicoureteral reflux (VUR) after 3 years of prospective follow-up. Over the last 3 years, 109 children (72 girls and 37 boys) with a mean age of 6.2 ± 3.4 years (mean ± SD) underwent endoscopic correction of reflux using Vantris. VUR was unilateral in 53 and bilateral in 56 patients comprising 165 renal refluxing units (RRUs). Of these, primary VUR was present in 139 RRUs (84.2%) and 26 (15.8%) were complex cases. Ultrasound scan was performed 1 month, 1 year, and 3 years after injection, and voiding cystourethrogram (VCUG) was performed 3 months, 1 year, and 3 years after endoscopic correction. The reflux was corrected in 153 RRUs (92.7%) after a single injection and in 7 RRUs (4.2%) after a second injection. In 5 RRUs (3.1%), VUR downgraded to grade I (3 RRUs) and grade II (2 RRUs) and they were taken off antibiotic prophylaxis. Two patients (1.8%) had afebrile urinary tract infections (UTIs) and 2 patients (1.8%) developed febrile UTI. VCUG was performed in 32 of 71 children (39.1%) who completed 1 year and in 6 of 15 (40%) who completed 3 years of follow-up. None showed VUR recurrence. Ultrasound scan demonstrated normal appearance of kidneys in all but 2 patients (1.8%). One patient required stent insertion because of deterioration of hydronephrosis that resulted in complete resolution of obstruction and another patient required ureteral reimplantation. Our data show that Vantris injection provides a high level of reflux resolution with good clinical outcome during prospective follow-up.