Vesico-ureteric reflux in adults with neuropathic bladders treated with Polydimethylsiloxane (Macroplastique((R)))

Objective: To establish the efficacy of Macroplastique (R) in treating vesi co-ureteric reflux (VUR) in adults with neuropathic bladder dysfunction, Patients and methods: Fifteen patients (12 male and three female), age rang e 19 to 80 years (mean age 38) were included in this study. Diagnosis was c onfirmed by videourodynamics. In seven patients reflux was present bilatera lly. Twenty-two refluxing ureters were treated. Twelve patients had detruso r hyper-reflexia, two had areflexic bladders and one had loss of bladder wa ll compliance. According to the International Grading System, 10 ureters ha d grade IV reflux, five had grade III reflux, five had grade II reflux, and two had grade I rc flux. Macroplastique (R) (0.5-1.5 ml) was injected subm ucosally under each ureteric orifice to convert the opening to a slit like shape. The patients were followed up from 9 to 68 months, Results: VUR was completely resolved in 72.7% (16) ureters following a sing le injection and in a further 4.5% (1) ureter following a second injection. 9.1% (2) ureters were improved and treatment failed in 13.7% (3) ureters. Two patients showed a recurrence of reflux and 4 years after primary inject ion and subsequently had a curative second injection, Most of the patients in whom VUR was cured or improved showed a reduction in laboratory proven u rinary infection rates. Conclusion: Macroplastique (R) produced an excellent result (86% with compl ete resolution or improvement of reflux) in treating VUR in adult neuropath ic bladders. This is comparable to larger studies carried out on the paedia tric population, This is an easy procedure, which avoids major surgery and can be performed as a day case. In cases of failure or recurrence, repeat i njection or open surgery can be undertaken without any added complications.