Vesicoureteral Reflux Management With Subureteral Injection of Polydimethylsiloxane in Cases of Recurrent Pyelonephritis in Transplanted Kidneys

Abstract

Background: Kidney graft pyelonephritis is a common complication after renal transplantation, often prompted by vesicoureteral reflux (VUR). An effective and minimally invasive strategy for managing reflux that allows a decrease in the risk of recurrent pyelonephritis is desirable. The aim of this study was to describe our experience with an endoscopic treatment with subureteral injection of polydimethylsiloxane for the treatment of recurrent pyelonephritis of renal grafts secondary to VUR. Methods: Between 2011 and 2016, 17 subureteral polydimethylsiloxane injection procedures were performed. Patient monitoring was done by outpatient consultation and medical record review. The number of pyelonephritis events before and after the procedure and its safety were compared. Results: Forty-six infection episodes occurred before the procedure (2.71 infections/patient/year) and 10 infection episodes occurred after the procedure (0.59 infections/patient/year), representing a 78.3% reduction of infections/patient/year. The procedure was well tolerated and safe, with no resultant obstructive complications or changes in renal function and no long-distance migration of the bulking agent detected by monitoring. Conclusion: Consistent endoscopic treatment with subureteral injection of the bulking agent polydimethylsiloxane to manage VUR in cases of recurrent pyelonephritis of kidney grafts is a non-invasive treatment option with a good success rate and safety profile. World J Nephrol Urol. 2016;5(4):71-78 doi: https://doi.org/10.14740/wjnu296w