Chonnam Med J.  2008 Apr;44(1):17-22. 10.4068/cmj.2008.44.1.17.

Technical Considerations of Endoscopic Subureteral Injection for the Treatment of Vesicoureteral Reflux

• Oh MM
• Kim HC
• Bae JH
• Park HS
• Kim JJ
• Moon DG

• KMID: 1973386
• DOI: http://doi.org/10.4068/cmj.2008.44.1.17

Abstract

The purpose of this study was to assess the long-term efficacy and the cause of failure in endoscopic subureteral injection for vesicoureteral reflux. For 5 years, a total of 73 patients (96 ureters) with primary grades I to V VUR were treated by one operator using subureteral injection of polydimethylsiloxane (PDS) and followed-up for more than 1 year. Cure was defined as an absence of VUR on voiding cystourethrography at 3 months after injection. Second and third injection was done for the failed cases. Statistical analyses were performed using the chi-square test. Endoscopic subureteral injection of PDS showed high success rate (82.3%) after single injection, 98% after second injection for the failed cases. Correction by grade was 75%, 83%, 89%, 83%, and 77% for grade I to V, respectively. In 17 units of second injection, cystoscopy showed mound displacement in 9 units, no volcano appearance but rather a broad elevation in 5 units, mound extrusion in 2 units, and distal ureteral fistula in 1 unit. Among 17 failed units, 58.8% (10/17) occurred in the first 18 months, meanwhile, failure rate decreased to 9.5% (7/74) in later 42 months during the 5 years' practice in our institute. In contrast to the generally accepted concept, the primary grade was not the main cause of success. Besides the primary reflux grade, available position according to the characteristics of the patients, injection method, the operator's skill and experience greatly affect the success rate.

Keyword

Vesicoureteral reflux; Endoscopy; Polydimethylsiloxane

MeSH Terms

Cystoscopy
Dimethylpolysiloxanes
Displacement (Psychology)
Endoscopy
Fistula
Humans
Ureter
Vesico-Ureteral Reflux
Dimethylpolysiloxanes

Figure

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  Fig. 1 Sonographic finding of the urinary bladder. (A) No specific echogenic was noted at the right ureteral orifice on preoperative sonography.(B) An echogenic nodule (arrow) of injected PDS is noted on post-operative sonography.

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  Fig. 2 Operative cystoscopic findings. (A) Creation of competent ureteral orifice by cystoscopic submucosal injection of PDS. (B) Competent ureteral orifice on the top of a 'volcano' after injection of PDS. (C) Incompetent ureteral orifice; a main mound (arrow) is seen above the ureteral orifice. (D) Incompetent ureteral orifice; a mound is still poorly seen around ureteral orifice at 5~7 o'clock. (E) Extrusion of PDS is seen due to mucosal necrosis after overcorrection. (F) Ureteral fistula at the right. ureteral orifice is seen. It might be the result of complete extrusion of PDS after overcorrection.

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