Endoscopic correction of vesicoureteral reflux in children using polyacrylate-polyalcohol copolymer (Vantris): 5-years of prospective follow-up

Stanisław Warchoł; Grażyna Krzemień; Agnieszka Szmigielska; Przemysław Bombiński; Krzysztof Toth; Teresa Dudek-Warchoł

doi:10.5173/ceju.2017.1226

Endoscopic correction of vesicoureteral reflux in children using polyacrylate-polyalcohol copolymer (Vantris): 5-years of prospective follow-up

Cent European J Urol. 2017;70(3):314-319. doi: 10.5173/ceju.2017.1226. Epub 2017 Jul 24.

Authors

Stanisław Warchoł¹, Grażyna Krzemień², Agnieszka Szmigielska², Przemysław Bombiński³, Krzysztof Toth⁴, Teresa Dudek-Warchoł¹

Affiliations

¹ Department of Pediatric Surgery and Urology, Medical University of Warsaw, Warsaw, Poland.
² Department of Paediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland.
³ Department of Paediatric Radiology, Medical University of Warsaw, Warsaw, Poland.
⁴ Nuclear Medicine Laboratory, Nukelomed, Warsaw, Poland.

Abstract

Introduction: The endoscopic correction of vesicoureteral reflux (VUR) in children is a currently well accepted therapy in many pediatric urology centers. Polyacrylate-polyalcohol copolymer (PPC), namely Vantris^®, is one of the tissue-augmenting substances used for endoscopic reflux therapy. The aim of this study was to evaluate the results with PPC in children.

Material and methods: From 2012 to 2016, 125 children (73 girls and 52 boys) aged 0.6-17.9 years (mean 4.9 ±3.58) were treated with PPC. VUR was unilateral in 64 and bilateral in 61 patients, comprising 197 renal refluxing units (RRUs) grades: II in 72, III in 50, IV in 33 and V in 42. Of these primary reflux was present in 132 RRUs and 65 were complex cases. Voiding cystourethrogram (VCUG) was done 3 months after procedure.

Results: Follow-up was completed in 89.6% of patients (112 children), and 89.8% of RRUs (177 out of 197). Reflux resolved in 86.4% of RRUs after single injection, in 99.4% after second and in 100% after the third. The only significant, but serious complication observed was late ureteral obstruction after PPC injection correcting high grade reflux, which required ureteral re-implantation. This complication was found in 9 out of 112 children (8%), and in 11 out of 177 RRUs (6.2%), 1.1 -2.9 years (mean 2 ±0.7) after the PPC injection. The longest follow-up reaches 4.5 years.

Conclusions: Our data show that the PPC injection is an effective procedure for treating all grades of VUR with high success rate. However, because of the possibility of late ureteral obstruction, which requires ureteroneocystostomy, long-term follow-up is mandatory.

Keywords: Vantris®; endoscopic correction of reflux; pediatric urology; polyalcohol-polyacrylate copolymer; ureteral obstruction; vesicoureteral reflux.