MP55-07 HISTOPATHOLOGICAL CHANGES ASSOCIATED WITH POLYACRYLATE POLYALCOHOL BULKING COPOLYMER (PPC, VANTRIS) INJECTION FOR PAEDIATRIC VESICOURETERAL REFLUX (VUR)

Abstract

You have accessJournal of UrologyPediatrics: Urinary Tract Infection and Vesicoureteral Reflux1 Apr 2016MP55-07 HISTOPATHOLOGICAL CHANGES ASSOCIATED WITH POLYACRYLATE POLYALCOHOL BULKING COPOLYMER (PPC, VANTRIS) INJECTION FOR PAEDIATRIC VESICOURETERAL REFLUX (VUR) Boris Chertin, Stanislav Kocherov, Ermelinda Mele, Simona Gerocarni Nappo, and Nicola Capozza Boris ChertinBoris Chertin More articles by this author , Stanislav KocherovStanislav Kocherov More articles by this author , Ermelinda MeleErmelinda Mele More articles by this author , Simona Gerocarni NappoSimona Gerocarni Nappo More articles by this author , and Nicola CapozzaNicola Capozza More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.598AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Endoscopic correction of VUR utilizing Vantris has demonstrated high efficacy not only during a short term period, but also during a long term follow up without VUR recurrence. We have hypothesized that the obstruction following endoscopic correction of VUR is related to the anatomical features of the UVJ rather than the type of material used for endoscopic correction. Therefore, we have retrospectively evaluated all cases of obstruction following endoscopic treatment of VUR in both departments over the last 5 years and have performed clinical and histological review of these patients. METHODS Study population comprised 2470 patients who underwent endoscopic correction of VUR utilizing Deflux (1790 children) and Vantris (680 patients). 9(0.5%) children (3 F and 6 M) in Deflux group and 8(1.2%) (4 F and 4 M) in Vantris group developed UVJ obstruction and required ureteral re-implantation. Tissue sections were stained with hematoxylin eosin and trichrome and examined under a light microscope. Nine primary obstructive megaureters after ureteral re-implantation served as controls. RESULTS All children developed obstruction during the period ranging from 2 to 49 months (average 16 months) following endoscopic correction. The primary reflux grade was III in 7, IV in 6 and V in 4 children respectively. The review of pretreatment VCUG demonstrated the presence of refluxing/obstructive ureter in 10(58.8%) out of 17 obstructive ureters showing true obstruction in 7 ureters (1 from Deflux and 6 from Vantris group). Histopathological analysis revealed a pseudocapsule composed of fibrous tissue and foreign body-type giant cells surrounding the Vantris implant in all patients. The distal part of the ureters demonstrated significant ureteral dilatation without ureteral fibrosis. In all patients, additional biopsies from the muscularis propria adjacent to the injection site were examined and showed no significant abnormalities. There was an increased collagen deposition in the juxtavesical segment of the obstructive ureters following Deflux, Vantris injection and also of primary obstructive megaureter. No significant difference was found in the tissue response between Deflux, Vantris patients and controls. CONCLUSIONS Our data show that Vantris injection does not lead to ureteral fibrosis or inflammatory changes and therefore does not seem to increase the incidence of UVJ obstruction. However, patients with high grade VUR and an initial underlying ureteral pathology should receive appropriate counseling upon surgery concerning the possibility of UVJ obstruction and the need in subsequent ureteral re-implantation. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e738 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Boris Chertin More articles by this author Stanislav Kocherov More articles by this author Ermelinda Mele More articles by this author Simona Gerocarni Nappo More articles by this author Nicola Capozza More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...