Landa JS, Hernández AG, Meneses JJH, Villatoro MJM, Hernández CC

Language: Spanish
References: 7
Page: 97-101
PDF size: 80.00 Kb.

ABSTRACT

Introduction. The medical treatment of the vesicoureteral reflux, waiting for spontaneous resolution, has changed with the use of bulking materials behind the ureter. Materials and methods. It was a prospective study made in 44 pediatric patients with different grades of reflux, treated with endoscopic application of polydimethylsiloxane (macroplastique) the mean follow up was 3 years. Twenty patients had bilateral reflux and twenty four unilateral. We also included a patient with ureteral duplication and two patients with neuropathic bladders secundary to myelodysplasia. Results. Forty four subureterals endoscopic applications of macroplastique was made in patients with ages between 2 and 14 years old. The most frequent grade of reflux was II and III bilateral. The mean follow-up was between 6 months to 3 years. The rate of success was 89% after one injection of this bulkin agent. In two cases the macroplastique just improve the grade of reflux from III to II and they need a second injection of macroplastique. The patients with neuropathic bladders just improve the reflux after the second injection of macroplastique. Discussion. The use of polydimethylsiloxane in the treatment of vesicoureteral reflux is a valid minimal invasion alternative with low morbidity, that can be performed in a outpatient setting because of its simplicity. The patients treated with this therapy require less antibiotic prophylaxis and potential cost-effectiveness. The polydimethylsiloxane is an hipoallergenic silicone elastomer easy to deliver with low migratory qualities that preserve the volume. These findings suggest the polydimethylsiloxane like the bulkin agent of choice for the treatment of vesicoureteral reflux in Mexico.

REFERENCES

1. Patrick C, Walsh, et al. Campbell’s urology. 7th ed. 1998; 61: 1859-96.

2. Salinas Casado, et al. Nueva clasificación del reflujo vésico ureteral. Arch Esp Urol 1992; 45: 449.

3. Schulman CC, et al. Endoscopic treatment of vesicourethral reflux in children. J Urol 1987; 138: 950-2.

4. Haferkamp A, M’ohring K, Staehler G, D’orsam J. Department of Urology. University of Heidelberg, Germany. Pitfalls of repeat subureteral bovine collagen injections for the endoscopic treatment of vesicoureteral reflux. J Urol 2000; 163(6): 1919-21.

5. Joyner BD, et al. Endoscopic substances for the treatment of vesico ureteral reflux. Urology 1997; 50: 489-94.

6. Puri P, Chertin B, Velayudham M, et al. Treatment of vesicoureteral reflux by endoscopic injection of dextranomer/hyaluronic acid copolymer: preliminary results. J Urol 2003; 170: 1541-4.

7. Diamond DA, Caldamone AA, Bauer SB, et al. Mechanisms of failure of endoscopic treatment of vesicoureteral reflux based on endoscopic anatomy. J Urol 2003; 170: 1556-9.