Calcified Macroplastique Substance: A Rare Cause of Recurrent Gross Hematuria after Endoscopic Injection

Abstract

Endoscopic subureteral injection for treatment of vesicoureteral reflux (VUR) is known to be safe and efficient due to its minimal invasive nature. Being non-migratory, non-antigenic, and biocompatible, Macroplastique (Polydimethylsiloxane) is likely to be stable over time. A 5-year-old boy with a past history of subureteral administration of Macroplastique for unilateral Grade V VUR 4 years ago presented with recurrent gross and microscopic hematuria, along with suprapubic pain. On computed tomography (CT) abdomen, calcified material, suspected to be a stone, was visualized in the bladder. On diagnostic cystoscopy, calcification was seen around the orifice site where Macroplastique injection had been performed. We removed the calcific material by Holmium laser. Endoscopic subureteric implantation has several advantages, but nevertheless, vigilance is needed to detect longterm complications, especially in patients with gross or microscopic hematuria.

Submucosal stone formation after 14-years of polydimethylsiloxane (Macroplastique®) endoscopic subureteric injection for vesicoureteral reflux: Unusual presentation for a rare complication

“…Agents can be autologous, such as fat or collagen, or non-autologous such as polytetraflurorethylene (PTFE), dextranomer hyaluronic copolymer (Deflux®), and polydimethylsiloxane (Macroplastique®). 3 The ideal injectable agent should be non-toxic, non-migratory, non-antigenic, and biocompatible but has not yet been discovered. 3 Macroplastique® is a silicon elastomer with widespread medical applications, such as pacemaker leads, artificial urinary sphincter, and others.…”

“… 3 The ideal injectable agent should be non-toxic, non-migratory, non-antigenic, and biocompatible but has not yet been discovered. 3 Macroplastique® is a silicon elastomer with widespread medical applications, such as pacemaker leads, artificial urinary sphincter, and others. 1 STING with Macroplastique® has acquired acceptance and popularity due to the material's effectiveness and safety.…”

“… 2 Treatment options include both medical and surgical therapies. 3 Under surgical options, there are open procedures, such as ureteral reimplantation or endoscopic therapy with subureteric injection of a bulking agent. The aim of subureteric injection is to lengthen the submucosal ureteric tunnel to an adequate length in order to prevent urine reflux.…”

“… 2 Endoscopic injection with polytetrafluoroethylene (PTFE) paste for VUR treatment was introduced in 1981 by Matouschek. 3 However, the classic subureteric Teflon injection (STING) technique was first described by O'Donnell and Puri in 1984. Different materials are available for subureteric implantation.…”

“…Different materials are available for subureteric implantation. 1 , 2 , 3 Macroplastique® gained popularity for VUR correction, although it has not yet been approved by the Food and Drug Administration (FDA). In this study, we report a case of unusual delayed presentation in the form of microscopic hematuria caused by calcified Macroplastique® after 14-years.…”