Late-onset Uretero-vesical Junction Obstruction Following Endoscopic Injection of Bulking Material for the Treatment of Vesico-ureteral Reflux

Published:December 16, 2016DOI:


      To characterize patients who develop late obstruction after subureteral injection of bulking agent for the treatment of pediatric vesicoureteral reflux (VUR).


      We retrospectively evaluated the medical records of all patients who underwent endoscopic injection for the correction of VUR during 2008-2015 in 2 centers in Israel: Bnai-Zion Medical Center, Haifa, and Schneider Children's Medical Center, Petah Tikva. Nine patients who developed late-onset obstruction were included in the study, and their data were reviewed and analyzed.


      Three boys and 6 girls with mean age of 3 years were included in the study. All patients had moderate-to-high grade VUR. Following injection, all children had a radiographic evidence showing resolution of the reflux. During follow-up, patients were diagnosed with late obstruction in a mean time of 13.4 months. All patients underwent open re-implantation.


      Late-onset obstruction may develop in patients treated with subureteral injection for VUR. Patients with high grade reflux and dilated ureters are at risk of late obstruction. Long-term follow-up with ultrasound is mandatory following endoscopic treatment of VUR.
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        • Peters C.
        • Rushton H.G.
        Vesicoureteral reflux associated renal damage: congenital reflux nephropathy and acquired renal scarring.
        J Urol. 2010; 184: 265-273
        • Simoes e Silva A.C.
        • Silva J.M.P.
        • Diniz J.S.S.
        • et al.
        Risk of hypertension in primary vesicoureteral reflux.
        Pediatr Nephrol Berl Ger. 2007; 22: 459-462
        • Swerkersson S.
        • Jodal U.
        • Sixt R.
        • Stokland E.
        • Hansson S.
        Relationship among vesicoureteral reflux, urinary tract infection and renal damage in children.
        J Urol. 2007; 178 (discussion 650-651): 647-651
        • O'Donnell B.
        • Puri P.
        Treatment of vesicoureteric reflux by endoscopic injection of Teflon. 1984.
        J Urol. 2002; 167 (discussion 1810): 1808-1809
        • Stenberg A.
        • Lackgren G.
        A new bioimplant for the endoscopic treatment of vesicoureteral reflux: experimental and short-term clinical results.
        J Urol. 1995; 154: 800-803
        • Stenberg A.M.
        • Sundin A.
        • Larsson B.S.
        • Lackgren G.
        • Stenberg A.
        Lack of distant migration after injection of a 125iodine labeled dextranomer based implant into the rabbit bladder.
        J Urol. 1997; 158: 1937-1941
        • Chertin B.
        • Arafeh W.A.
        • Zeldin A.
        • Kocherov S.
        Preliminary data on endoscopic treatment of vesicoureteric reflux with polyacrylate polyalcohol copolymer (Vantris®): surgical outcome following single injection.
        J Pediatr Urol. 2011; 7: 654-657
        • Lavelle M.T.
        • Conlin M.J.
        • Skoog S.J.
        Subureteral injection of deflux for correction of reflux: analysis of factors predicting success.
        Urology. 2005; 65: 564-567
        • Chertin B.
        • Kocherov S.
        Long-term results of endoscopic treatment of vesicoureteric reflux with different tissue-augmenting substances.
        J Pediatr Urol. 2010; 6: 251-256
        • Guerra L.A.
        • Khanna P.
        • Levasseur M.
        • Pike J.G.
        • Leonard M.P.
        Endoscopic treatment of vesicoureteric reflux with deflux: a Canadian experience.
        J Can Urol Assoc. 2007; 1: 41-45
        • Vandersteen D.R.
        • Routh J.C.
        • Kirsch A.J.
        • et al.
        Postoperative ureteral obstruction after subureteral injection of dextranomer/hyaluronic acid copolymer.
        J Urol. 2006; 176: 1593-1595
        • Zemple R.P.
        • Potretzke A.M.
        • Kryger J.V.
        Delayed onset ureteral obstruction following Deflux® injection for vesicoureteral reflux.
        J Pediatr Urol. 2012; 8: e23-e26
        • Sencan A.
        • Yildirim H.
        • Ozkan K.U.
        • Ucan B.
        • Karkiner A.
        • Hosgor M.
        Late ureteral obstruction after endoscopic treatment of vesicoureteral reflux with polyacrylate polyalcohol copolymer.
        Urology. 2014; 84: 1188-1193
        • Griffiths D.J.
        Flow of urine through the ureter: a collapsible, muscular tube undergoing peristalsis.
        J Biomech Eng. 1989; 111: 206-211
        • Al-Hunayan A.A.
        • Kehinde E.O.
        • Elsalam M.A.
        • Al-Mukhtar R.S.
        Outcome of endoscopic treatment for vesicoureteral reflux in children using polydimethylsiloxane.
        J Urol. 2002; 168: 2181-2183
        • Rubenwolf P.C.
        • Ebert A.K.
        • Ruemmele P.
        • Rösch W.H.
        Delayed-onset ureteral obstruction after endoscopic dextranomer/hyaluronic acid copolymer (Deflux) injection for treatment of vesicoureteral reflux in children: a case series.
        Urology. 2013; 81: 659-662