Endoscopic treatment of vesicoureteral reflux using polyacrilate polyalcohol bulking copolymer (Vantris)

Abstract

Purpose. Recently published date on high recurrence rate following successful treatment of VUR has prompted the search for different injectable substances with non- biodegradable nature. We have evaluated an outcome of endoscopic correction VUR utilizing Vantris as a new non- biodegradable tissue-augmentinq substance in stady. Material and methods. From 2011 to 2016 331 patientes (117 boys and 214 girls) with a mean age of 3.56 years (range 8m – 14 years) were treated with Vantris. VUR was unilateral in 219 and bilateral 112 patients comprising 443 renal refluxing units (RRU).Of these, primary VUR was present in 371(86%) RRU and 72(14%) were complex cases. Reflux was grades 1 to IV 68(15,3%), 266 (60%) and 109(24,6%) RRU respectively. Patients were monitored with US at 1, 3, 6 and 12 months, and 2 and 3 years VCUG - 1 and 2 years. Results. Reflux resolved in 411 RRU (92, 8%) after first injection, in 9 ( 2% ) after second and in 2 (0,45%) after third injection respectively. VUR improved to grade 1 in 16 ( 3,6% ) ureters, which needed no further treatment. Injection failed to correct reflux in 3 (0, 7 %), which were then treated with ureteral reimplantation. None showed VUR recurrence. US demonstrated normal appearance of kidneys in all but 15 (3,2 %) patients.VUJ obstructions requiring ureteral reimplantation developed in 2 ( 0,47%) ureters. Two (0, 47%) RRU requiring stent insertion due to deterioration ureterohydronephrosis resulted in complete resolution of obstruction. Seventeen (5% ) patients suffered afebrile and 2 (0,6%) developed febrile UTI. None demonsrated VUR recurrens. Conclussion. The results of this survey confirm that endoscopic subureteral Vantris injection is a simple,safe,and effective outpatient procedure for treating VUR in patients over 2-3 years.