Abstract
Purpose of the review: Vesicoureteral reflux (VUR) is a common pathology encountered in pediatric urology. If left untreated, this condition can lead to infectious complications, hypertension and loss of renal function by scars. There is a trend for minimally invasive procedures to minimise treatment-related complications. Endoscopic subureteral injection of bulking agent in the treatment of VUR is an example of minimally invasive options. Several bulking agents have been studied and the perfect agent has not yet been discovered. Polyacrylamide hydrogel is a relatively new agent used to treat VUR and its use will be reviewed. Recent findings: Three modern studies from a Canadian group have evaluated the use of polyacrylamide hydrogel for endoscopic injection to treat VUR. The first study reported a cure rate of 81.2% without major complication. In the second study, injection of polyacrylamide hydrogel was compared to dextranomer hyaluronic acid and no significant difference was observed, with overall success rate of 73.1% and 77.5% respectively. The third trial evaluated the long-term efficacy and safety of polyacrylamide hydrogel with a 36-month follow-up. Overall success at 3 months was 70.7% and no patient had de novo hydronephrosis or calcification of the agent at 36 months. Conclusion: Polyacrylamide hydrogel seems to be a safe and effective alternative bulking agent in the treatment of VUR. The contribution from other centers to validate those data would be valuable.
Highlights
Vesicoureteral reflux (VUR) is frequently encountered in pediatric urology practice and overall estimated prevalence is between 1 and 3 %1,2
Purpose of the review: Vesicoureteral reflux (VUR) is a common pathology encountered in pediatric urology
Vesicoureteral reflux is a major concern in pediatric urology and management aim to prevent consequences without creating new comorbidities
Summary
Vesicoureteral reflux (VUR) is frequently encountered in pediatric urology practice and overall estimated prevalence is between 1 and 3 %1,2. The clinical correlation of retrograde flow of urine with pyelonephritis was first described in the 1950s-1960s by Hutch[3]. Renal scarring and loss of renal function due to VUR with UTI is well established. The leading cause of hypertension in children and young adult is renal scarring or dysplasia secondary to VUR4. The objectives to manage this pathology aim to prevent recurrent febrile UTIs, prevent renal injury and minimize the morbidity associated with different treatment options and follow-up[5]. Management options are: active surveillance, continuous antibiotic prophylaxis, endoscopic injections of bulking agents and open, laparoscopic or robotic ureteral reimplantation[5,6]
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