title: Autologous adipocyte graft in endoscopic treatment of vesico-renal reflux in children: a preliminary study.
abstract: No bulking agent is ideal for endoscopically treating vesico-renal reflux in children. Many teams have tried to find a safe and efficient material, ideally an autologous material. We describe here a protocol for the use of autologous viable fat in the treatment of primary vesico-renal reflux in children aged from 3 to 15 years. Fat harvesting was done from the medial side of the thigh by manual aspiration. Samples were centrifuged to purify the graft from blood and lipid. Lastly fat was injected beneath the pathologic ureter by a conventional endoscopic technique. A voiding cystourethrography (VCUG) closed the procedure. Follow-up included renal ultrasonography the day after surgery, and one and three months later. A VCUG was performed systematically at three months and, in cases of acute pyelonephritis, during the survey.Sixty-four children with 94 refluxing units were treated by autologous fat injection with a follow-up from 6 to 40 months. At the end of the procedure, we systematically obtained a very good increase in height of the pathologic meatus and VCUG was normal in all cases. None presented with an obstruction during the follow-up period. Two children presented with an acute pyelonephritis before the third month. At three months, VCUG was not realized in 14 cases (22%) because the parents refused the procedure. One of those children presented with an acute pyelonephritis five months after endoscopic treatment. VCUG was normal for 17 of 50 children (34%), and showed a real improvement for 19 other children (38%). Three children had a surgical reimplantation because of the persistence of an unchanged high-grade vesico-renal reflux; histological examination found viable adipocytes on sections of the distal pathologic ureter. Clinically, 11 children (17%) presented with an acute pyelonephritis after treatment at a mean follow-up time of 10 months.These preliminary findings led us to modify the technique in order to improve our results. Our first concern is feasibility and safety of this technique, regardless of the use of other synthetic bulking agents the innocuousness of which is uncertain.
authors: University Hospital of Strasbourg, Strasbourg, France.
authors: Isabelle
authors: I
authors: Lacreuse
authors: Raphael
authors: R
authors: Moog
authors: Vanessa
authors: V
authors: Kadoch
authors: Michel
authors: M
authors: Fischbach
authors: Marile-Laurence Poli
authors: ML
authors: Merol
authors: François
authors: F
authors: Becmeur
references: J Biomed Mater Res B Appl Biomater. 2006 Apr;77(1):171-8
references: 16211572
references: Arch Pathol Lab Med. 1983 Nov;107(11):611-2
references: 6688722
references: Eur Urol. 2002 Dec;42(6):598-606; discussion 606
references: 12477657
references: Aesthet Surg J. 2003 Jul-Aug;23(4):265-9
references: 19336086
references: Plast Reconstr Surg. 2003 Jun;111(7):2315-23
references: 12794474
references: Clin Plast Surg. 1997 Apr;24(2):347-67
references: 9142473
references: Plast Reconstr Surg. 1986 Jul;78(1):122-3
references: 3725947
references: J Pediatr. 2002 Feb;140(2):230-4
references: 11865276
references: Eur Urol. 1993;23(3):394-9
references: 8508896
references: Ann Plast Surg. 1991 Mar;26(3):248-58
references: 2029135
references: Urology. 1997 Oct;50(4):489-94
references: 9338720
references: J Urol. 2003 Oct;170(4 Pt 2):1563-5
references: 14501661
references: J Urol. 2003 Jan;169(1):313-6
references: 12478179
references: Dermatol Surg. 2001 Sep;27(9):819-26
references: 11553171
references: Br Med J (Clin Res Ed). 1984 Jul 7;289(6436):7-9
references: 6428669
references: Aesthetic Plast Surg. 1996 Sep-Oct;20(5):403-8
references: 8849432
references: Eur Urol. 1990;17(4):328-9
references: 2194818
references: J Urol. 1989 Sep;142(3):821-2
references: 2671416
references: JAMA. 1984 Jun 22-29;251(24):3277-81
references: 6374180
references: J Urol. 1994 Aug;152(2 Pt 2):819-21
references: 8022023
references: Arch Esp Urol. 1989 Mar;42(2):143-6
references: 2735779
references: Ann Chir Plast Esthet. 2001 Feb;46(1):31-8
references: 11233732