title: Late-onset Uretero-vesical Junction Obstruction Following Endoscopic Injection of Bulking Material for the Treatment of Vesico-ureteral Reflux.
abstract: OBJECTIVE
  To characterize patients who develop late obstruction after subureteral injection of bulking agent for the treatment of pediatric vesicoureteral reflux (VUR).
  
  
  METHODS
  We retrospectively evaluated the medical records of all patients who underwent endoscopic injection for the correction of VUR during 2008-2015 in 2 centers in Israel: Bnai-Zion Medical Center, Haifa, and Schneider Children's Medical Center, Petah Tikva. Nine patients who developed late-onset obstruction were included in the study, and their data were reviewed and analyzed.
  
  
  RESULTS
  Three boys and 6 girls with mean age of 3 years were included in the study. All patients had moderate-to-high grade VUR. Following injection, all children had a radiographic evidence showing resolution of the reflux. During follow-up, patients were diagnosed with late obstruction in a mean time of 13.4 months. All patients underwent open re-implantation.
  
  
  CONCLUSIONS
  Late-onset obstruction may develop in patients treated with subureteral injection for VUR. Patients with high grade reflux and dilated ureters are at risk of late obstruction. Long-term follow-up with ultrasound is mandatory following endoscopic treatment of VUR.
authors.affiliation: Department of Urology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Ben-Meir
authors.affiliation: Department of Urology, Bnai-Zion Medical Center, Haifa, Israel. Electronic address: Zaher.bahouth@b-zion.org.il.
authors.forename: Zaher
authors.initials: Z
authors.lastname: Bahouth
authors.affiliation: Department of Urology, Bnai-Zion Medical Center, Haifa, Israel.
authors.forename: Sarel
authors.initials: S
authors.lastname: Halachmi
mesh_terms: D002675:Child, Preschool; D000070621:Cystography; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000009:adverse effects*; D006869:Hydronephrosis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D015552:Injections, Intralesional / Q000009:adverse effects / Q000379:methods; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014513:Ureter; D014517:Ureteral Obstruction / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D001748:Urinary Bladder Neck Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000379:methods; D014718:Vesico-Ureteral Reflux / Q000628:therapy*; D055675:Viscosupplements / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D055675:Viscosupplements; D006820:Hyaluronic Acid