Long-term results of endoscopic treatment of vesicoureteral reflux with the sub-ureteric injection of calcium hydroxyapatite.
OBJECTIVE
To review our long-term results of the sub-ureteric injection of calcium hydroxyapatite in the endoscopic management of vesicoureteral reflux (VUR) in children.


METHODS
A sub-ureteric injection of calcium hydroxyapatite was given to 14 children (23 ureteral units) affected by VUR grades I-V. All children were followed-up with monthly urine cultures, and a renal ultrasound was done on the postoperative 4th week, while the first voiding cysto-urethrogram (VCUG) control was performed on postoperative week 12. The children were followed-up with yearly renal ultrasound and monthly urine cultures, thereafter. Data from the patients' charts were retrospectively analyzed regarding the outcome of the procedures.


RESULTS
Mean follow-up time was 52 months (47-60 months). VUR was cured in 47.4% of cases after a single injection. After the second injection the global success rate was 52.1%. Ureteroneocystostomy was performed on seven refluxing ureters of five children unresponsive to sub-ureteric injection therapy. One patient underwent nephroureterectomy because of a non-functioning kidney secondary to ureteral obstruction due to migration of material at the 23rd month postoperatively.


CONCLUSIONS
Although favorable short-term success rates have been reported with the sub-ureteric injection of calcium hydroxyapatite without any side effects, our long-term results showed a low success rate, with the only reported serious morbidity.
Tarcan
Tufan
T
Department of Urology, Marmara University School of Medicine, Marmara University Hospital, Tophanelioglu Caddesi 13-15, Altunizade, Istanbul, 34662, Turkey. tufan@marmara.edu.tr
Tinay
Ilker
I
Temiz
Yusuf
Y
Simşek
Ferruh
F
D001672:Biocompatible Materials / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D017886:Durapatite / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007267:Injections; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014513:Ureter; D018666:Ureteroscopy; D014718:Vesico-Ureteral Reflux / Q000628:therapy*
D001672:Biocompatible Materials; D017886:Durapatite