title: Relative contraindication to endoscopic subureteral injection for vesicoureteral reflux: congenital refluxing megaureter with distal aperistaltic segment.
abstract: OBJECTIVE
  Endoscopic subureteral injection for the management of vesicoureteral reflux has become a well-established first-line minimally invasive treatment strategy. One potential pitfall is the creation of ureteral obstruction. No predictors are available to determine which patients will develop this rare, but real, complication.
  
  
  METHODS
  A retrospective evaluation of 2 girls, aged 3 and 4 years, with grade 4 and 3 reflux, respectively, and documented ureteral obstruction after endoscopic treatment with dextranomer/hyaluronic acid copolymer. Before treatment, both patients had had refluxing megaureters with a distal aperistaltic segment.
  
  
  RESULTS
  Ultimately, they both required open, cross-trigonal ureteral reimplantation with resolution of vesicoureteral reflux and ureteral obstruction.
  
  
  CONCLUSIONS
  Congenital refluxing megaureter with a distal aperistaltic segment might be a relative contraindication to endoscopic subureteral injection of a bulking agent for the management of vesicoureteral reflux.
authors.affiliation: Department of Urology, University of California, San Francisco, School of Medicine, San Francisco, California 94117, USA. daaronson@urology.ucsf.edu
authors.forename: David S
authors.initials: DS
authors.lastname: Aaronson
authors.forename: Sameer A
authors.initials: SA
authors.lastname: Siddiqui
authors.forename: Yuri
authors.initials: Y
authors.lastname: Reinberg
authors.forename: Laurence S
authors.initials: LS
authors.lastname: Baskin
mesh_terms: D002675:Child, Preschool; D000075202:Contraindications; D003911:Dextrans / Q000008:administration & dosage*; D004724:Endoscopy; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007267:Injections; D010528:Peristalsis; D014513:Ureter / Q000002:abnormalities* / Q000503:physiopathology; D014718:Vesico-Ureteral Reflux / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology
chemical_list: D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid