Efficacy of endoscopic subureteral polydimethylsiloxane injection for treatment of vesicoureteral reflux in children: A North American clinical report

Purpose: Subureteral injection of bulking agents is an accepted surgical treatment of vesicoureteral reflux in children. Polydimethylsiloxane, a silicone elastomer, is an ideal agent because of bulky consistency, lack of migration, minimal local inflammatory reaction and is safe in laboratory animals. We record our experience with endoscopic subureteral polydimethylsiloxane injection in children for vesicoureteral reflux. Materials and Methods: During a 2-year period 16 boys and 58 girls, with an average age of 8 years, with 112 refluxing ureters underwent endoscopic subureteral polydimethylsiloxane injection to treat vesicoureteral reflux. Vesicoureteral reflux was grade I in 8, II in 43, III in 50, IV in 10 and V in 1 ureter. Operative indications were breakthrough urinary tract infection in 29 children, nonresolution of reflux 38 and high grade reflux 7. All procedures were on an outpatient basis and performed with patient under general anesthesia. All children had a postoperative ultrasound and voiding cystourethrogram at 12 weeks. Followup was from 6 to 24 months. Results: Overall, reflux was corrected in 90 (81%) ureters and 56 (76%) children after a single injection. With repeat injection reflux was corrected in 101 (90%) ureters and 63 (85%) children. Correction by grade was 85%, 84%, 80%, 45% and 0% for grades I to V, respectively. With repeat injection correction was 100%, 92%, 90% and 55% for grades I to IV, respectively. There were no surgical complications. De novo contralateral reflux developed in 2 (3%) children. There were 3 (4%) children who required open ureteral reimplantation for failed injection. Detection of the polydimethylsiloxane implant by followup ultrasound was 89% sensitive and 86% specific for the correction of reflux. Conclusions: Endoscopic subureteral polydimethylsiloxane injection is an effective treatment of vesicoureteral reflux in children. The procedure is safe with low associated morbidity. The presence of the polydimethylsiloxane implant can be documented accurately by ultrasound, and there is a strong correlation between implant stability and correction of reflux.