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Endoscopic Correction Of Complex VUR Cases Utilizing Vantris As A New Non-Biodegradable Tissue Augmenting Substance
Boris Chertin, MD, Wael Abu Arafeh, MD, Stanislav Kocherov, MD.
Shaare Zedek Medical Center, Jerusalem, Israel.
BACKGROUND: Recently published data on endoscopic correction of primary VUR utilizing Vantris as a new non biodegradable tissue augmenting substance demonstrated high success rate with no recurrence during long term follow up. We aimed to evaluate prospectively the efficacy of Vantris in children with complex cases of VUR.
METHODS: Over the last 4 years 37 children (28 female and 9 male) with a mean age of 5.8+ 3.1 years (mean+ SD) underwent endoscopic correction of complex VUR. A total of 38 renal refluxing units (RRU) was treated as 5 had persistent reflux after open surgery, 16 had duplication, 4 had Hutch diverticulum, 6 had small poorly functioning kidneys (less than 20% of relative renal function) with grade V VUR, 2 had ureterocele after puncture, 3 had persistent stump reflux, 1 had prune belly syndrome, and 1 had urogenital sinus. VUR was Grade I in 2, Grade II in 9, Grade III in 11, Grade IV in 10 and Grade V in 6 RRU respectively. 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 34 (89.4%) RRU after a single injection, after second injection in 2 (5.3 %) RRU. In 2 (5.3%) RRU VUR downgraded to Grade I (1RRU) and Grade II (1RRU) and they were taken off antibiotic prophylaxis. An average of 0.8 cc (range 0.6-1.1) of Vantris was injected per ureter. Three (7.9%) patients suffered afebrile UTI. Two (5.2%) developed febrile UTI. None of those patients demonstrated VUR recurrence on VCUG. VCUG was performed in 11(73.3%) of 15 children who completed one year and in 3 (33.3%) of 9 who completed 3 years of follow up as a part of the routine protocol. None showed VUR recurrence. US demonstrated normal appearance of kidneys in all patients.
Our data show that Vantris injection provides a high level of reflux resolution in complex cases of VUR with no recurrence during prospective follow up.
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