The early experience and technical aspects of endoscopic subureteral polydimethylsiloxane injection for vesicoureteral reflux

Hyun Chul Kim, Kang Soo Shim, Du Geon Moon

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose: We reviewed the operative outcome and the cause of failure for performing subureteral injection of polydimethylsiloxane (PDS, Macroplastique®, Uroplasty Inc. Geleen, The Netherlands), when it is used as a bulking agent for the endoscopic treatment of vesicoureteral reflux (VUR) patients. Materials and methods: A total of 29 patients (a total of 37 ureters), with primary grades I to V VUR were treated with a single subureteral injection from 2001 to 2004; these patients were followed for an average of 21.5 months. Each patient underwent preoperative voiding cystourethrography, renal ultrasound, a dimercapto-succinic acid (DMSA) scan and urine culture. With the patient under general anesthesia, the PDS implant was injected transurethrally at the 6 o'clock position of the ureteral opening in the affected renal unit by a modified subureteral transurethral injection (STING) procedure. Renal ultrasound was done at 1 week and voiding cystourethrography was done at 3 months to rule out obstruction at the injection site and/or persistent reflux, respectively. Cure was defined as an absence of VUR on voiding cystourethrography at 3 months after injection. Statistical analyses were performed using the chi-square test. Results: The grade of reflux was I, II, III, IV and V in 6, 4, 12, 9 and 6 ureteral units respectively. After a single injection, the VUR was cured in 30 ureteral units (81.1%). There were 7 (18.9%) patients who received a second injection after a failed single injection. In these patients, the injected PDS volume was not changed on ultrasound. On the other hand, cystoscopy showed mound displacement in 4 patients, no volcano appearance but rather a broad elevation in 2 patient, and distal ureteral fistula and mound extrusion in 1 patient. Conclusions: These results suggest that endoscopic subureteral polydimethylsiloxane injection is an effective treatment of VUR. The efficacy of subureteral injection can be improved by using the correct injection technique.

Original languageEnglish
Pages (from-to)154-159
Number of pages6
JournalKorean Journal of Urology
Volume47
Issue number2
Publication statusPublished - 2006 Feb 1

Fingerprint

Vesico-Ureteral Reflux
Injections
Kidney
baysilon
Cystoscopy
Succinic Acid
Chi-Square Distribution
Ureter
Netherlands
General Anesthesia
Fistula
Urine

Keywords

  • Injections
  • Polydimethylsiloxane
  • Vesicoureteral reflux

ASJC Scopus subject areas

  • Urology

Cite this

The early experience and technical aspects of endoscopic subureteral polydimethylsiloxane injection for vesicoureteral reflux. / Kim, Hyun Chul; Shim, Kang Soo; Moon, Du Geon.

In: Korean Journal of Urology, Vol. 47, No. 2, 01.02.2006, p. 154-159.

Research output: Contribution to journalArticle

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abstract = "Purpose: We reviewed the operative outcome and the cause of failure for performing subureteral injection of polydimethylsiloxane (PDS, Macroplastique{\circledR}, Uroplasty Inc. Geleen, The Netherlands), when it is used as a bulking agent for the endoscopic treatment of vesicoureteral reflux (VUR) patients. Materials and methods: A total of 29 patients (a total of 37 ureters), with primary grades I to V VUR were treated with a single subureteral injection from 2001 to 2004; these patients were followed for an average of 21.5 months. Each patient underwent preoperative voiding cystourethrography, renal ultrasound, a dimercapto-succinic acid (DMSA) scan and urine culture. With the patient under general anesthesia, the PDS implant was injected transurethrally at the 6 o'clock position of the ureteral opening in the affected renal unit by a modified subureteral transurethral injection (STING) procedure. Renal ultrasound was done at 1 week and voiding cystourethrography was done at 3 months to rule out obstruction at the injection site and/or persistent reflux, respectively. Cure was defined as an absence of VUR on voiding cystourethrography at 3 months after injection. Statistical analyses were performed using the chi-square test. Results: The grade of reflux was I, II, III, IV and V in 6, 4, 12, 9 and 6 ureteral units respectively. After a single injection, the VUR was cured in 30 ureteral units (81.1{\%}). There were 7 (18.9{\%}) patients who received a second injection after a failed single injection. In these patients, the injected PDS volume was not changed on ultrasound. On the other hand, cystoscopy showed mound displacement in 4 patients, no volcano appearance but rather a broad elevation in 2 patient, and distal ureteral fistula and mound extrusion in 1 patient. Conclusions: These results suggest that endoscopic subureteral polydimethylsiloxane injection is an effective treatment of VUR. The efficacy of subureteral injection can be improved by using the correct injection technique.",
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