ENDOSCOPIC TREATMENT OF VESICOURETERAL REFLUX WITH A CHONDROCYTE-ALGINATE SUSPENSION

Injection of polytetrafluoroethylene (Teflon) or collagen has been use d in the endoscopic treatment of vesicoureteral reflux. Although the p rinciple of an endoscopic treatment is valid, there are concerns regar ding the long-term safety and effectiveness of these substances. In se arch of a different injectable material we conducted experiments using chondrocytes in a biodegradable polymer solution for the treatment of vesicoureteral reflux in an animal model. Reflux was created in 4 min i-pigs and confirmed with a cystogram. Cartilage was obtained from the auricular surface of each animal. Chondrocytes were harvested and exp anded in vitro. The cells were individually quantitated and concentrat ed to 40 million cells per cc. The cell suspensions were mixed with a sodium alginate and calcium sulfate solution. Each pig was injected un ilaterally in the subureteral region with the autologous chondrocyte s uspension. The opposite ureter served as an internal control in all an imals. Cystograms showed resolution of reflux in the treated side and persistence of reflux in the opposite untreated side in each instance. Excretory urograms revealed no evidence of obstruction. Histological examination of the subureteral region demonstrated cartilage. Autologo us chondrocytes can be readily harvested, expanded in vitro and inject ed cystoscopically. The cells survive and form a cartilage nidus that is nonantigenic. This system is able to correct reflux without any evi dence of obstruction.