The Irish paediatrics association and section of paediatrics, royal academy of medicine in Ireland

Since the initial experimental studies in pigs, treatment of vesicoureteral reflux (VUR)inehildrenby endoscopic subureteral injection of polytetrafluoroethylene paste has been used by several investigators with encouraging results. Thirty-seven children (32 girls, 5 boys) with VUR in duplex systems were treated endnscopieally by the senior author (PP) using subureteric Polytef O~ injection and followed up for 1 to 7 years. Thirty-one patients had unilateral refluxing duplex systems and six had bilateraIrefluxing duplex systems. Twenty-sevenrefluxing units had complete ureteral duplication and 16 had incomplete uretesal duplication. All refluxing units had higher grade VUR at least into one of the moieties of the duplex system; 74% of the refluxing duplex ureters having grade 1II VUR and 26% either grade 1V or grade V reflux. Reflux was corrected in 14 (87%) of the 16 ureters with incomplete ureteral duplication after a single injection of Polytet ~ paste and two ureters required two injections to correct VUR. Of the 27 refluxing units with complete ureteral duplication, reflux was corrected in 16 (59%) units after a single injection of Polytef~ paste. 3 (11%) duplex systems showed improvement to grade ] or II reflux after one injection and no further treatment was given. Eight (30%) units with complete ureteral duplication required two to four subureteric injections for the correction of VUR. 93% of refluxing units where reflux was corrected with one subureteric injection of PolytolX~t paste required less than 0.3ml of paste per unit to stop reflux. Thirty-six o f the 37 patients were discharged from the hospital on the day of the procedure. At follow-up micturating cystography 93% of duplex systems continue to show absence of reflux 1 to 7 years after endoscopic correction. There was no evidence of delayed appearance of vesicoureteral obstruction on sonography. No significant complications have been observed in our patients with the use of Teflon to correct reflux. This endoscopic day care procedure offers a simple ahemative in the treatment of refluxing duplex systems.