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19–22 APRIL, 2017, BARCELONA, SPAIN
09:02–09:05
S5-3 (PP)
URETERAL OBSTRUCTION AS A LATE AND SINGNIFICANT
COMPLICATION AFTER ENDOSCOPIC CORRECTION
OF VESICOURETERIC REFLUX IN CHILDREN USING
POLYACRYLATE-POLYALCOHOL COPOLYMER (VANTRIS)
Stanislaw WARCHOL
1
, Grazyna KRZEMIEN
2
, Agnieszka SZMIGIELSKA
2
,
Przemyslaw BOMBINSKI
3
, Michal BRZEWSKI
3
, Krzysztof TOTH
4
and Teresa DUDEK-WARCHOL
1
1) Medical University of Warsaw, Department of Pediatric Surgery and Urology, Warsaw, POLAND - 2) Medical
University of Warsaw, Department of Pediatrics and Nephrology, Warsaw, POLAND - 3) Medical University of Warsaw,
Department of Pediatric Radiology, Warsaw, POLAND - 4) Nuclear Medicine Laboratory Nukleomed, Warsaw, POLAND
PURPOSE
Postoperative obstruction after endoscopic treatment of VUR using various bulking substances is
reported phenomenon. The aim of the study was to present late ureteral obstruction after Vantris
injection requiring operative treatment.
MATERIAL AND METHODS
During the last 4 years 110 children with 173 renal refluxing units (RRUs) grades: II in 69, III in
42, IV in 30 V in 32, underwent successfull endoscopic correction of VUR using Vantris. VCUG
was done 3 months after procedure, then patients were followed up by ultrasonography (US) and
radionuclide scan every 6 months. In 9 children with 11 RRUs (pretreatment grades IV and V) late
ureteral obstruction was recognized.
RESULTS
Progressive dilatation of renal collecting system and megaureter (US study) as well as deterioration
of renal function with delayed excretion (radionuclide study) was found 1.1-2.9 years (mean 2 ± 0.7)
after Vantris injection in 8 children, in the 9
th
child after 0.9 yrs. All nine were qualified for operative
treatment. Politano-Leadbetter antireflux procedure after excison of stenotic intravesical part of
ureter was performed in 7 children: unilaterally in 5, bilaterally in 2. Two children did not show up for
the planned surgery. Postoperative US and dynamic scintigraphy (mran follow-up 1 year) showed
gradually decrease of dilatation of the upper urinary tract and permanent improvement of drainage
and renal function.
CONCLUSIONS
Late ureteral obstruction, even years after endoscopic treatment with VANTRIS presents serious
complication. Long term follow-up is therefore obligatory despite the fact that reflux resolved after
injection.
09:05–09:14
Discussion