The use of polyacrylate-polyalcohol copolymer hydrogel in the endoscopic treatment of primary vesicoureteral reflux in children

Abstract Background/purpose It is still under discussion which is the best tissue augmenting substance for the endoscopic treatment of children with vesicoureteral reflux (VUR). We describe our preliminary experience (September 2009–November 2011) with polyacrylate-polyalcohol copolymer hydrogel (PPCH). Methods This is an observational, descriptive, prospective study which included 81 female and male patients (age 1–14 years) diagnosed with unilateral (n=45) and bilateral (n=36) primary VUR comprising a total of 117 refluxing renal units (RRU). Complex cases were excluded from the study. All patients were clinically and radiologically evaluated and those who met the inclusion criteria were treated endoscopically with a single subureteral injection of PPCH by a single surgeon. 11 patients (13.5%) had a pathological 99mTc-DMSA before treatment. The volume of injected product was measured in all cases. Results were considered successful if 6months postinjection, conventional voiding cystourethrogram (VCUG) revealed VUR was cured (Grade 0). Follow-up ranged from 7 to 32months. Results The overall resolution rate based on the number of RRUs studied was 92.3% (108/117). The mean injected volume of PPCH per patient was 0.6ml. One patient with obstructive anuria required vesicoureteral reimplantation. Other complications were persistent, self-limiting hematuria (n=2); lumbar pain (n=4) and urinary tract infection with normal VCUG (n=4). Conclusions Our short term data show PPCH provides a high level of reflux resolution in selected patients. Long term follow-up is required.