Ureterovesical reimplantation after failure of endoscopic treatment of reflux: anatomical and histological study of 61 resection specimens in 40 children

Objective: To evaluate the anatomy and histology of the ureterovesical junc tion resected during secondary surgical reimplantation for persistent reflu x after failure of initial endoscopic treatment by polytetrafluoroethylene (Teflon (R)) in 27 cases and polydimethylsiloxane (Macroplastique (R)) in 1 3 cases. Material and Method: 61 ureterovesical junctions from 40 children were stud ied histologically. The mean age of the patients at the time of the operati on was 4.1 years (range: 1 to IS years). The mean interval between endoscop ic injection and surgical reimplantation was 15.3 months (range: 2 to 54 mo nths). Results: Persistent reflux was nor correlated with the anatomical situation of the implant, which was found to be in a satisfactory position in 52.4% of cases. Both of the substances used induced a giant-cell macrophage react ion which colonized the implant and triggered new vessel formation. Macropl astique (R) appeared to be associated with a more intense inflammatory reac tion than Teflon (R). Despite the difference in particle size, the two substances induced a macro phage phenomenon characterized by microfragmentation into 6 micron particle s. No conclusions can be drawn concerning distant migration, but this study showed rarefaction of particles which were replaced by fibrosis, the densi ty of which was correlated with the age of the implant. Conclusion: Extinction of the local reaction induced by the products used i n this study appears to be long and the end of this process is unknown, whi ch justifies prolonged surveillance of children treated for reflux by endos copic submeatal injection.