The durability of a single successful endoscopic polytetrafluoroethylene injection treatment: 14 year followup results

Abstract

Purpose Long term durability of success after endoscopic correction with a single injection of bulking agents has not been addressed. It is not agreed on how and for how long we should follow up these cases. We reviewed our 14-year experience with successful single endoscopic subureteral poltetrafluoroethylene (PTFE) injection for the treatment of primary vesicoureteral reflux in children. Material and methods We retrospectively reviewed the charts of 42 patients with primary vesicoureteral reflux who were treated with a single successful subureteral PTFE injection from 1989 to 1993 and followed-up by routine 1, 3, and 10-year voiding cystourethrograms. Results The study included 30 girls and 12 boys between 2 years and 14 years old (median age 6 years). Four patients were lost to follow-up. Of the 38 patients 28 had unilateral and 10 had bilateral primary vesicoureteral reflux. Endoscopic treatment by subureteral PTFE injection was performed in 48 ureters. Patients were followed 10-14 years with a mean follow-up of 12.5±2.1. Voiding cystourethrography in 38 patients with 48 ureters revealed that 35 ureters (73%) remain free of reflux whereas reflux recurred in 13 (27%). Median recurrence time was 2 years. Of these 13 ureters, recurring reflux was grade I-II in 5 and grade III-V in 8. Reflux recurred in 11 of 24 ureters with grade IV-V reflux. 10 of 13 recurrences were detected by febrile urinary tract infections and only 3 Grade I recurrences were detected by voiding cystourethrography alone. No untoward effects were seen in any of these patients with injection of PTFE. Conclusions Following a single successful endoscopic injection for vesicoureteral reflux long-term follow-up may be warranted particularly in high-grade reflux. However, follow-up voiding cystourethrograms can be avoided except for cases with a febrile urinary tract infection.