Abstract
ABSTRACTPurpose Subureteral injection of bulking agents in the endoscopic treatment of vesicoureteral reflux is widely accepted therapy with high success rates. Although the grade of vesicoureteric reflux and experience of surgeon is the mainstay of this success, the characteristics of augmenting substances may have an effect particularly in the long term. In this retrospective study, we aimed to evaluate the clinical outcomes of the endoscopic treatment of vesicoureteric reflux (VUR) with two different bulking agents: Dextranomer/hyaluronic acid copolymer (Dx/HA) and Polyacrylate polyalcohol copolymer (PPC).Materials and Methods A total 80 patients (49 girls and 31 boys) aged 1-12 years (mean age 5.3 years) underwent endoscopic subureteral injection for correction of VUR last six years. The patients were assigned to two groups: subureteral injections of Dx/HA (45 patients and 57 ureters) and PPC (35 patients and 45 ureters). VUR was grade II in 27 ureters, grade III in 35, grade IV in 22 and grade V in 18 ureters.Results VUR was resolved in 38 (66.6%) of 57 ureters and this equates to VUR correction in 33 (73.3%) of the 45 patients in Dx/HA group. In PPC group, overall success rate was 88.8% (of 40 in 45 ureters). Thus, Thus, this equates to VUR correction in 31 (88.5%) of the 35 patients.Conclusions Our short term data show that two different bulking agent injections provide a high level of reflux resolution and this study revealed that success rate of PPC was significantly higher than Dx/HA with less material.
Highlights
The endoscopic injection technique for the treatment of vesicoureteric reflux (VUR) was first described in adults by Matouschek in 1981 and the first clinical series was reported by O’Donnell and Puri in 1984
The success rates mainly depend on the VUR grade, surgeon’s experience, anatomic localization of ureters, the nature of the bulking material may have an effect on the success rates [1,2,3]
We reported the outcomes and success rates of two different bulking agents (Dx/HA and Polyacrylate polyalcohol copolymer (PPC)) and analyzed the factors affecting the results in the endoscopic treatment of VUR in children
Summary
The endoscopic injection technique for the treatment of VUR was first described in adults by Matouschek in 1981 and the first clinical series was reported by O’Donnell and Puri in 1984. A relatively new tissue augmenting material polyacrylate polyalcohol copolymer (PPC, Vantris®, Promedon, Cordoba, Argentina) is a non-biodegradable bulking agent that belongs to the family of acrylics: particles of polyacrylate polyalcohol copolymer. This copolymer is immersed in glycerol with a physiological solution carrier. After the implantation of PPC, it induces fibroblastic growth by high superficial electronegativity to be covered by a fibrous capsule. This fibrotic capsule leads to stability and endurance of injected material, affects the local and distant migration and the success rate [7]
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