Subureteral Polydimethylsiloxane Injection Versus Extravesical Reimplantation For Primary Low Grade Vesicoureteral Reflux in Children: A Comparative Study

Abstract

No AccessJournal of UrologyPEDIATRIC UROLOGY1 Jan 2003Subureteral Polydimethylsiloxane Injection Versus Extravesical Reimplantation For Primary Low Grade Vesicoureteral Reflux in Children: A Comparative Study HAMDY ABOUTALEB, STÉPHANE BOLDUC, JYOTI UPADHYAY, WALID FARHAT, DARIUS J. BÄGLI, and ANTOINE E. KHOURY HAMDY ABOUTALEBHAMDY ABOUTALEB , STÉPHANE BOLDUCSTÉPHANE BOLDUC , JYOTI UPADHYAYJYOTI UPADHYAY , WALID FARHATWALID FARHAT , DARIUS J. BÄGLIDARIUS J. BÄGLI , and ANTOINE E. KHOURYANTOINE E. KHOURY View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64114-6AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We compare the outcome of extravesical ureteral reimplantation to endoscopic polydimethylsiloxane (Macroplastique, Uroplasty, Inc., Minneapolis, Minnesota) subureteral injection for primary low grade vesicoureteral reflux in children. Materials and Methods: Between 1997 and 2000, 180 patients underwent polydimethylsiloxane injection (74, 108 ureters) or extravesical ureteral reimplantation (106, 166 ureters) for low grade vesicoureteral reflux. Low grade reflux was defined as grades I to III. Outcome analysis included success rates, de novo hydronephrosis, voiding efficiency, urinary tract infections and complications. Results: Mean patient age at surgery for the injection and surgery groups was 60 and 77 months, and mean followup was 12 and 15 months, respectively. Of the patients who underwent single injection 80.6% were cured of reflux at 3 months and 91.6% were cured at last followup. Success rate after reimplantation was 95.8% at 3 months which improved to 98.8% 1 year later. The success rate was significantly different between the injection and reimplantation groups at 3 and 12 months (p <0.01). Postoperative complications in the reimplantation group included transient urinary retention after bilateral surgery in 2 patients (3.3%), suprapubic fluid collections in 2 and wound seroma in 1. No complications occurred in the polydimethylsiloxane group. Conclusions: Extravesical ureteral reimplantation has near perfect success with a low but definite complication rate. Polydimethylsiloxane offers high success rates for reflux in an ambulatory setting with no short-term complications. Currently, endoscopic polydimethylsiloxane injection is our preferred mode of therapy for low grade vesicoureteral reflux in children when surgical correction is indicated. References 1 : Pediatric Vesicoureteral Reflux Guidelines Panel summary report on the management of primary vesicoureteral reflux in children. J Urol1997; 157: 1846. Link, Google Scholar 2 : Extravesical nondismembered ureteroplasty with detrusorhaphy: a renewed technique to correct vesicoureteral reflux in children. J Urol1992; 148: 704. Link, Google Scholar 3 : Detrusorrhaphy: extravesical ureteral advancement to correct vesicoureteral reflux in children. J Urol1987; 138: 947. Link, Google Scholar 4 : Are postoperative studies justified after extravesical reimplantation?. J Urol2000; 164: 1064. Link, Google Scholar 5 : Multicenter survey of endoscopic treatment of vesicoureteral reflux using polytetrafluoroethylene. J Urol1998; 160: 1007. Link, Google Scholar 6 : Endoscopic injection of gluteraldehyde cross-linked bovine dermal collagen for correction of vesicoureteral reflux. J Urol1991; 145: 115. Link, Google Scholar 7 : Migration and granulomatous reaction after periurethral injection of polytef (Teflon). JAMA1984; 251: 3277. Crossref, Medline, Google Scholar 8 : Endoscopic substances for the treatment of vesicoureteral reflux. Urology1997; 50: 489. Crossref, Medline, Google Scholar 9 : Evaluation of polydimethylsiloxane as an alternative in the endoscopic treatment of vesicoureteral reflux. J Urol1994; 152: 1221. Link, Google Scholar 10 : Efficacy of endoscopic subureteral polydimethylsiloxane injection for treatment of vesicoureteral reflux in children: a Nort