2005, Number 2
Rev Mex Urol 2005; 65 (2)
Subureteral endoscopic application of polydimethylsiloxane (macroplastique) in the treatment of vesicoureteral reflux
Landa JS, Hernández AG, Meneses JJH, Villatoro MJM, Hernández CC
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ABSTRACTIntroduction. The medical treatment of the vesicoureteral reflux, waiting for spontaneous resolution, has changed with the use of bulking materials behind the ureter. Materials and methods. It was a prospective study made in 44 pediatric patients with different grades of reflux, treated with endoscopic application of polydimethylsiloxane (macroplastique) the mean follow up was 3 years. Twenty patients had bilateral reflux and twenty four unilateral. We also included a patient with ureteral duplication and two patients with neuropathic bladders secundary to myelodysplasia. Results. Forty four subureterals endoscopic applications of macroplastique was made in patients with ages between 2 and 14 years old. The most frequent grade of reflux was II and III bilateral. The mean follow-up was between 6 months to 3 years. The rate of success was 89% after one injection of this bulkin agent. In two cases the macroplastique just improve the grade of reflux from III to II and they need a second injection of macroplastique. The patients with neuropathic bladders just improve the reflux after the second injection of macroplastique. Discussion. The use of polydimethylsiloxane in the treatment of vesicoureteral reflux is a valid minimal invasion alternative with low morbidity, that can be performed in a outpatient setting because of its simplicity. The patients treated with this therapy require less antibiotic prophylaxis and potential cost-effectiveness. The polydimethylsiloxane is an hipoallergenic silicone elastomer easy to deliver with low migratory qualities that preserve the volume. These findings suggest the polydimethylsiloxane like the bulkin agent of choice for the treatment of vesicoureteral reflux in Mexico.