Injection Of Calcium Hydroxyapatite Research Articles

Late Onset Ureteric Obstruction After Endoscopic Subureteric Injection of Calcium Hydroxyapatite for Primary Vesicoureteric Reflux

Ureteric obstruction occurs in about 1% of cases undergoing endoscopic treatment of vesicoureteric reflux (VUR). It usually develops shortly after treatment. We report on a case of obstruction occurring 1 year after subureteric injection of calcium hydroxyapatite. Obstruction was progressive and eventually required open ureteric reimplantation. Ureteric obstruction can occur also in the long-term after endoscopic treatment of VUR and even in the absence of symptoms. Although it is so rare as to make long-term follow-up of all treated cases cost ineffective, physicians should be aware of such complications, especially while testing new bulking agents.

Long-term results of endoscopic treatment of vesicoureteral reflux with the sub-ureteric injection of calcium hydroxyapatite

To review our long-term results of the sub-ureteric injection of calcium hydroxyapatite in the endoscopic management of vesicoureteral reflux (VUR) in children. A sub-ureteric injection of calcium hydroxyapatite was given to 14 children (23 ureteral units) affected by VUR grades I-V. All children were followed-up with monthly urine cultures, and a renal ultrasound was done on the postoperative 4th week, while the first voiding cysto-urethrogram (VCUG) control was performed on postoperative week 12. The children were followed-up with yearly renal ultrasound and monthly urine cultures, thereafter. Data from the patients' charts were retrospectively analyzed regarding the outcome of the procedures. Mean follow-up time was 52 months (47-60 months). VUR was cured in 47.4% of cases after a single injection. After the second injection the global success rate was 52.1%. Ureteroneocystostomy was performed on seven refluxing ureters of five children unresponsive to sub-ureteric injection therapy. One patient underwent nephroureterectomy because of a non-functioning kidney secondary to ureteral obstruction due to migration of material at the 23rd month postoperatively. Although favorable short-term success rates have been reported with the sub-ureteric injection of calcium hydroxyapatite without any side effects, our long-term results showed a low success rate, with the only reported serious morbidity.

Tratamiento endoscópico del reflujo de vesicoureteral en pediatría: Experiencia preliminar con la inyección subureteral de coaptite®

To review our experience in the endoscopic treatment of vesicoureteral reflux (VUR) in children with the subureteral injection of calcium hydroxyapatite (Coaptite).The serie includes thirteen children whose age ranged between 6 and 13 years. The Coaptite implant was injected subureterally to 20 ureteral units (UU) affected by VUR grades I-IV. VUR was unilateral in six patients (46%), bilateral in seven (54%). There were 7 primary cases and 6 secondary to bladder dysfunction and duplex systems.Mean follow-up was 19 months (6-28 months). VUR was cured in 75% of cases after a single injection. A second injection resolved 2 out of 4 treated UU (50%) rendering a global success rate of 85%. This cure rate was achieved for 13 and 7 procedures treating primary and secondary VUR, respectively. 77% of patients reported no adverse events with only 23% of them complaining of transient mild lumbar and hypogastric discomfort limited to the first postoperative day. In 2 children postoperative urinary infection was detected.Endoscopic subureteral injection with Coaptite is a simple technique well tolerated in children. In 85% of primary and secondary cases cure was achieved with minimal morbidity.

Vocal cord medialisation by transcutaneous injection of calcium hydroxyapatite

Objectives: Various techniques of vocal cord medialization have been described. The 2 most commonly used procedures are medialization thyroplasty and injection augmentation of the vocal cord. Translaryngeal injection of agents to cause cord medialization has increasingly become the route of choice as it is quick, simple and does not require general anaesthesia. Various agents have been injected but none are without problems. Calcium hydroxyapatite has recently been advocated as a potentially superior alternative. The aims of this study were to investigate the short and medium term patient benefits of calcium hydroxyapatite for vocal cord medialization via trancutaneous injection. Methods: A retrospective analysis of 24 patients undergoing transcutaneous vocal cord injection with calcium hydroxyapatite was performed. The primary diagnosis was vocal cord paralysis in 20 patients and vocal cord scarring in the remaining 4. Results: The mean age of the patient group was 66.7 years (SD 15.7). Due to various factors including patient death and distance to travel, follow-up is incomplete. Maximum phonation time (MPT) was taken as the performance measure. Twenty-two patients had a preinjection MPT (average 4, SD 1.7); 12 patients had follow-up at 3 months (mean MPT 10.3, SD 6.5). The mean preinjection MPT of this group was 4.25 (SD 1.8); 5 patients had follow-up at 6 months (mean MPT 10.6, SD 3.0). The mean preinjection MPT of this group was 4.5 (SD 1.7). In 2 patients the injection of calcium hydroxyapatite entered the submucosal space of the vocal cord but only 1 patient required surgical removal of the substance. Conclusion: Transcutaneous injection of calcium hydroxyapatite gives satisfactory improvement in maximum phonation time for glottic insufficiency due to vocal cord paralysis in the short and medium term. Longer term follow-up studies are in progress and these will further evaluate the outcome and safety of calcium hydroxyapatite as a substance for vocal cord medialization.