Experience of subureteral polydimethylsiloxane injection treatment in children with vesicoureteral reflux

Purpose: Our data was retrospectively reviewed to assess the efficacy, safety and costs of endoscopic subureteral polydimethylsiloxane (PDS, Macroplastique®) injection treatment for children with vesicoureteral reflux (VUR). Materials and Methods: Between December 1997 and May 2006, a total of 24 (29 renal units) VUR patients, whose parents showed reluctance toward open surgery, underwent subureteral PDS injection treatment. All of the patients were postoperatively assessed by voiding cystourethrography (VCUG) and ultrasound to evaluate any complications and reflux. The medical costs of the injection treatment were compared with those of open surgery for VUR over the same period. Results: The mean follow-up was 15 months (range 2-72). Of the 29 renal units treated, 24 (82.8%) were cured. Hydronephrosis, which postoperatively developed in three renal units, was spontaneously improved or resolved after minimal endourological procedures. Temporary gross hematuria and voiding difficulty occurred in one patient each, but were also improved. The total medical costs of the injection treatment were cheaper than those of open surgery (p < 0.05). Conclusions: An endoscopic subureteral PDS injection is an effective and safe procedure; in addition, compared to open surgery, is an economic treatment for children with VUR.