Endoscopic treatment with polydimethylsiloxane in children with dilating vesico-ureteric reflux.
OBJECTIVE
To report our experience of treating dilating vesico-ureteric reflux (VUR) in children, using an injectable form of polydimethylsiloxane (Macroplastique, MPQ; Uroplasty BV, Geleen, The Netherlands), as medical treatment for moderate or severe VUR is associated with a high proportion of persistence or development of new scars.


METHODS
The study included 32 children (40 ureters) with VUR; 13 (32%) were grade III, 20 (50%) grade IV and seven (18%) grade V. They were treated over a period of 42 months, 66% for some form of bladder dysfunction and 38% had associated diseases. The main indications were VUR grade, recurrent urinary tract infection and progression of reflux nephropathy. MPQ was injected under general anaesthesia via an 11 F cystoscope, x 30 objective, with a 5 F working channel.


RESULTS
The mean (sd) follow-up was 28.5 (10.2) months; VUR resolved in 80% of patients and improved to minimal VUR in the remaining 20%. The resolution/improvement rate was 72% after the first injection, 97% after the second and 100% after the third. There were no significant complications.


CONCLUSIONS
The endoscopic implantation of MPQ always corrected VUR even though 68% of the cases were grade IV-V. It should become the treatment of choice for severe VUR.
Cattedra di Chirurgia Pediatrica, Department of Surgical Science, University of Foggia, Via Luigi Pinto, 71100 Foggia, Italy. bartolifabio@libero.it
Fabio
F
Bartoli
Francesco
F
Niglio
Ottavio
O
Gentile
Rosa
R
Penza
Gabriella
G
Aceto
Samuele
S
Leggio
D000283:Administration, Intravesical; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003558:Cystoscopy / Q000379:methods; D004129:Dimethylpolysiloxanes / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D016896:Treatment Outcome; D014718:Vesico-Ureteral Reflux / Q000628:therapy*
D004129:Dimethylpolysiloxanes