Endoscopic correction of vesico-ureteric reflux by subureteric Teflon injection: follow-up ultrasound and voiding cystography

Abstract

The technique of subureteric Teflon injection for the correction of vesico-ureteric reflux was first described by Puri and O'Donnell in 1984. The Teflon granuloma that occurs after the injection anchors the submucosal ureter, thereby preventing reflux. This paper reviews the ultrasound and cystographic findings in 88 patients with 115 refluxing ureters followed-up for periods ranging from 3 months to 3 years. Reflux disappeared in 91 ureters (79.1%) and the degree of reflux improved in 22 ureters (19.1%). In this follow-up study, the size of the granuloma on ultrasound was assessed in relation to the number of injections, the total volume of Polytef paste used and the outcome of the procedure. A well circumscribed granuloma was seen at the orifices of 92 ureters. There was no ureteric granuloma evident in 23 ureters and Teflon plaques were found at the trigone in six patients. Complications were rare. One large granuloma caused severe obstruction requiring re-implantation. The size of the granuloma appears to depend on individual tissue reaction rather than on the other factors. The presence or the size of the granuloma bears no direct relationship to the success of the procedure.

Role of the Teflon deposit in the recurrence of vesicoureteral reflux

“…The number of new renal scars was higher in the deposit (−) group, meaning that the lack of the deposit might have influenced the condition of the kidney. Previous reports and our results all support the notion that successful anti-reflux treatment probably does influence the progression of reflux nephropathy in most cases [16,17]. The new information on STING treatment gained from our study (that the recurrence of reflux is significantly influenced by the absence of the Teflon deposit in the long-term) might be useful for those experts-paediatricians, paediatric nephrologists, urologists, paediatric surgeons and radiologists-who take part in the follow-up of children that have undergone subureteric Teflon injection.…”

The clinical utility and safety of the endoscopic treatment of vesicoureteral reflux in patients with duplex ureters

“…Of these, seven studies did not discuss the safety or tolerability of the treatment [11,13,33,35,36,44,45,50]. Among those six studies that did report some information on safety findings, the following was noted.…”

Bladder ultrasound in the evaluation of the efficacy of dextranomer/hyaluronic acid injection for treatment of vesicoureteral reflux

“…[3][4][5][6] Being a noninvasive and widespread imaging modality, renal/bladder sonography has been widely used to determine the size and precise location of the subureteral mass as well as for the evaluation of hydroureteronephrosis after the injection. 3,5,[7][8][9][10] Although some investigators have suggested that the size and volume of the implant as assessed with imaging studies may be an important factor in predicting the outcome of the procedure, this assumption could not be supported entirely. 3,7,8 Recently, Herz et al 9 reported that sonography was accurate in identifying the presence of subureteral implant and correlating implant stability on renal sonography with correction of reflux after polydimethylsiloxane injection.…”

“…3,5,[7][8][9][10] Although some investigators have suggested that the size and volume of the implant as assessed with imaging studies may be an important factor in predicting the outcome of the procedure, this assumption could not be supported entirely. 3,7,8 Recently, Herz et al 9 reported that sonography was accurate in identifying the presence of subureteral implant and correlating implant stability on renal sonography with correction of reflux after polydimethylsiloxane injection. In the current study, we describe the sonographic assessment of a subureteral implant after endoscopic DHA injection.…”