Incidence of UVJ obstruction during long-term follow-up after endoscopic correction of VUR utilizing polyacrylate polyalcohol copolymer (PPC)

Abstract

Purpose We present a long-term follow-up of patients who underwent VUR correction with polyacrylate polyalcohol copolymer (PPC) injection with an emphasis on UVJ obstruction and urinary tract infection. Methods During 2009-2012, 157 children (106 girls and 51 boys) with mean age of 4.8 ± 2.8 years (mean ± SD) underwent endoscopic correction of VUR using PPC. VUR was unilateral in 74 patients and bilateral in 83, comprising 240 renal reflux units (RRU). Of these, primary VUR was present in 197 RRU (82.1%) and 43 (17.9%) were complex cases. Median followup was 7 years (range 6-10 years). Average volume of PPC was 1.2 ml (range 0.6-1.8 ml) Results Reflux was corrected in 222 RRU (92.5%) after a single injection, and in 10 RRU (4.2%) after the second injection. In RRU 7 (2.9%), reflux downgraded to Grade I and II, and they were taken off antibiotic prophylaxis. One patient (0.4%) failed endoscopic correction and required ureteral reimplantation (UR). 11 (4.6%) RRU developed UVJ obstruction, of which 9 (3.8%) required UR. All patients developed obstruction between 1 and 2 years after injection. Nineteen (12.1%) patients developed low UTI, and 12 (7.6%) patients developed febrile UTI during follow-up. None of these patients demonstrated reflux recurrence. Conclusion Our data indicate that endoscopic correction utilizing PPC does not increase the risk of obstruction during long-term follow-up.