This group from Italy assessed their endoscopic treatment of dilating vesico-ureteric reflux (VUR) in children with polydimethylsiloxane (MacroplastiqueTM, MPQ; Uroplasty BV, Geleen, The Netherlands).
They had a 72% success rate after the first injection, 97% after the second, and 100% after the third. Interestingly, their patient population had 68% of the cases with grade IV–V VUR.
The study included 32 children (40 ureters) with VUR; 13 (32%) were grade III, 20 (50%) grade IV and seven (18%) grade V. They were treated over a period of 42 months. There were 66% with some form of bladder dysfunction and 38% had other issues. The main indications for intervention were VUR grade, recurrent urinary tract infection and progression of reflux nephropathy. The mean follow-up was 28.5 months (sd 10.2). VUR resolved in 80% of patients and improved to minimal VUR in the remaining 20%. The resolution/improvement rate was 72% after the first injection, 97% after the second and 100% after the third. There were no significant complications.
Although mostly replaced by Deflux (Q-Med, Scandinavia) in the United States, the MPQ use in this study seems favorable as well. The group concluded that the endoscopic implantation of MPQ always corrected VUR even though 68% of the cases were grade IV–V and that it should become the treatment of choice for severe VUR. As endoscopic treatment becomes more mainstream, it will be interesting to see which product has a more lasting resolution with minimal side effects.
By Pasquale Casale, MD
Reference:
BJU International, 97(4): 805-808, April 2006.
http://www.ncbi.nlm.nih.gov/entrez/