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Endoscopic Correction of VUR Utilizing Vantris As A NEW NON-Biodegradable Tissue Augmenting Substance. Three YEARS of Prospective Followup

Sunday, October 21, 2012: 9:24 AM
Grand Ballroom B (Hilton Riverside)
Boris Chertin, MD, Wael Abu Arafeh and Stanislav Kocherov, Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel

Purpose Recently, intriguing data regarding high recurrence rate following successful Dx/HA treatment of VUR was presented prompting the search for different injectable substances with non biodegradable nature. We have evaluated the efficacy of Vantris in children with VUR after three years of the prospective follow up.

Methods Over the last 3 years 109 children (72 female and 37 male) with a mean age of 6.2+ 3.4 years (mean+ SD) underwent endoscopic correction of reflux utilizing Vantris. VUR was unilateral in 53 and bilateral in 56 patients comprising 165 renal refluxing units (RRU). Of these, primary VUR was present in 139 (84.2%) RRU and 26 (15.8%) were complex cases. VUR was Grade I in 10, Grade II in 23, Grade III in 110, Grade IV in 13 and Grade V in 9 RRU. US was performed one month, one year and 3 years after injection, VCUG was performed 3 months, one year and 3 years after endoscopic correction.

Results The reflux was corrected in 153 (92.7%) RRU after a single injection, after second injection in 7 (4.2 %) RRU. In 5 (3.1%) RRU VUR downgraded to Grade I (3RRU) and Grade II (2RRU) and they were taken off antibiotic prophylaxis. Two (1.8%) patients suffered afebrile UTI. Two (1.8%) developed febrile UTI. VCUG was performed in 28(39.4%) of 71 children who completed one year and in 2 (28.6%) of 7 who completed 3 years of follow up. None showed VUR recurrence. One patient demonstrated De-novo reflux. US demonstrated normal appearance of kidneys in all but two (1.8%) patients. One required stent insertion due to deterioration of hydronephrosis resulted in complete resolution of obstruction and another one required ureteral reimplantation.

Conclusion

Our data show that Vantris injection provides a high level of reflux resolution with no recurrence during prospective follow up.