Long-term results of endoscopic correction of vur in complex cases using Vantris as a non-biodegradable tissue augmenting substance

Objective: To evaluate the long-term efficacy of Vantris in complex cases in children with vesicoureteral reflux (VUR). Material and methods: Over the last 3 years, 77 children (41 girls and 36 boys) with a mean age of 5.2± 2.1 years (mean ± SD) underwent endoscopic correction of reflux using Vantris. VUR was unilateral in 47 and bilateral in 30 patients comprising 107 renal refluxing units (RRUs). Of these, primary VUR was present in 52 RRUs and 55 were complex cases. VUR was considered as complex case in case of presence of neurogenic voiding dysfunction (NVD), previous operations, bladder extrophy/ epispadias complex (BEEC) cases, duplex system. Ultrasound scan and was performed 1 month, 1 year, and 3 years after injection, and voiding cystourethrogram (VCUG) was performed 3 months, 1 year, and 3 years after endoscopic correction. Results: VUR successful correction was based mainly on absence of febrile UTI and upper urinary tract dilatation. The reflux in complex cases was corrected in 43 RRUs (78,2%) after a single injection and in 2 RRUs (3,6%) after a second injection. In 2 cases VUR was successfully corrected (VUR degree downgraded from IV to II) at the same time with bladder neck reconstruction in patients with BEEC. In patients with NVD VUR was corrected in 18 RRUs (64.3%). In 6 patients endoscopic VUR correction with Vantris was combined with botulinum toxin injection in bladder (4 cases) and bladder neck (2 cases), two of those patients required second botulinum toxin injection. In one case salvage VUR correction was done in patient with previous failed ureterocystoneoimplantaion (less than 3 months ago, so re-do operation was not possible), VUR grade decreased from 5 to 2 with 1 year free of UTI period. VCUG was performed in 18 of 26 children who completed 1 year and in 4 of 10 who completed 3 years of follow-up. None showed VUR recurrence. Ultrasound scan demonstrated normal appearance of kidneys in all but 3 patients (5.4%). One patient required stent insertion because of deterioration of ureterohydronephrosis that resulted in complete resolution of obstruction and two patients required ureteral reimplantation. Conclusion: Our data show that Vantris injection provides a quite high level of reflux resolution with good clinical outcome even in complex cases such as bladder extrophy/ epispadias complex, neurologic voiding dysfuction, duplex system and previous operations.