Efficacy of endoscopic subureteral polydimethylsiloxane injection for treatment of vesicoureteral reflux in children: A North American clinical report

Purpose: Subureteral injection of bulking agents is an accepted surgical tr eatment of vesicoureteral reflux in children. Polydimethylsiloxane, a silic one elastomer, is an ideal agent because of bulky consistency, lack of migr ation, minimal local inflammatory reaction and is safe in laboratory animal s. We record our experience with endoscopic subureteral polydimethylsiloxan e injection in children for vesicoureteral reflux. Materials and Methods: During a 2-year period 16 boys and 58 girls, with an average age of 8 years, with 112 refluxing ureters underwent endoscopic su bureteral polydimethylsiloxane injection to treat vesicoureteral reflux. Ve sicoureteral reflux was grade I in 8, II in 43, III in 50, IV in 10 and V i n 1 ureter. Operative indications were breakthrough urinary tract infection in 29 children, nonresolution of reflux 38 and high grade reflux 7. All pr ocedures were on an outpatient basis and performed with patient under gener al anesthesia. All children had a postoperative ultrasound and voiding cyst ourethrogram at 12 weeks. Followup was from 6 to 24 months. Results: Overall, reflux was corrected in 90 (81%) ureters and 56 (76%) chi ldren after a single injection. With repeat injection reflux was corrected in 101 (90%) ureters and 63 (85%) children. Correction by grade was 85%, 84 %, 80%, 45% and 0% for grades I to V, respectively. With repeat injection c orrection was 100%, 92%, 90% and 55% for grades I to IV, respectively. Ther e were no surgical complications. De novo contralateral reflux developed in 2 (3%) children. There were 3 (4%) children who required open ureteral rei mplantation for failed injection. Detection of the polydimethylsiloxane imp lant by followup ultrasound was 89% sensitive and 86% specific for the corr ection of reflux. Conclusions: Endoscopic subureteral polydimethylsiloxane injection is an ef fective treatment of vesicoureteral reflux in children. The procedure is sa fe with low associated morbidity. The presence of the polydimethylsiloxane implant can be documented accurately by ultrasound, and there is a strong c orrelation between implant stability and correction of reflux.