title: Results of Treatment of Grades IV and V Vesicoureteral Reflux with Endoscopic Injection of Polyacrylate Polyalcohol Copolymer.
abstract: OBJECTIVE
  Here we report the results of a review of a prospectively maintained database of the use polyacrylate polyalcohol copolymer (PPC) injection to correct grades IV and V VUR.
  
  
  METHODS
  All children with grades IV and V primary VUR that presented with febrile urinary tract infection while on prophylaxis, in a 3-year period, were treated with a sub-ureteral injection of PPC. Institutional ethical approval was obtained. Exclusion criteria were incomplete bladder emptying documented on videourodynamic study, ureteral duplication, paraureteral diverticula, and poor ureteral emptying observed during fluoroscopy and previous open surgical or endoscopic treatment. Pre- and post-operative evaluation included urinalysis, renal and bladder ultrasonography, DMSA scan, and videourodynamic studies.
  
  
  RESULTS
  Thirty-three children [36 renal units (RU)] were included with a median age of 57 months (range 7-108). There were 18 boys and 15 girls. Thirty RU had grade IV and 6 grade V VUR. Median follow-up time was 32 months (range 7-58). Reflux was cured in 32/36 RU with the first injection, but another two patients were reimplanted because of dilatation. Complications included early urinary tract infection in seven children, transient lower urinary tract symptoms in five children. Progressive ureteral dilatation was noted in four children and was treated with insertion of a double J stent. Two of these children eventually required an ureteroneocystostomy.
  
  
  CONCLUSIONS
  The use of PPC to treat grades IV and V vesicoureteral reflux in young children has an overall success rate of 83.3%. Persistent ureteral dilatation was present in 11% associated with high injection volume. Future studies will attempt to maintain a high success rate reducing the volume of injection and the incidence of dilatation.
authors.affiliation: Hospital Italiano de Buenos Aires , Buenos Aires , Argentina.
authors.forename: Francisco Ignacio
authors.initials: FI
authors.lastname: De Badiola
authors.affiliation: Hospital Italiano de Buenos Aires , Buenos Aires , Argentina.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Soria
authors.affiliation: Hospital Italiano de Buenos Aires , Buenos Aires , Argentina.
authors.forename: Roberto Luis
authors.initials: RL
authors.lastname: Vagni
authors.affiliation: Hospital Italiano de Buenos Aires , Buenos Aires , Argentina.
authors.forename: María Nieves
authors.initials: MN
authors.lastname: Ormaechea
authors.affiliation: Hospital Italiano de Buenos Aires , Buenos Aires , Argentina.
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Moldes
authors.affiliation: Hospital Italiano de Buenos Aires , Buenos Aires , Argentina.
authors.forename: César
authors.initials: C
authors.lastname: Benmaor
keywords: children; endoscopic injection; high grade vesico-ureteral reflux; polyacrylate polyalcohol copolymer; vantris