Abstract
Objective: To establish the efficacy of Macroplastique® in treating vesico-ureteric reflux (VUR) in adults with neuropathic bladder dysfunction.
Patients and methods: Fifteen patients (12 male and three female), age range 19 to 80 years (mean age 38) were included in this study. Diagnosis was confirmed by videourodynamics. In seven patients reflux was present bilaterally. Twenty-two refluxing ureters were treated. Twelve patients had detrusor hyper-reflexia, two had areflexic bladders and one had loss of bladder wall compliance. According to the International Grading System, 10 ureters had grade IV reflux, five had grade III reflux, five had grade II reflux, and two had grade I reflux. Macroplastique® (0.5–1.5 ml) was injected submucosally under each ureteric orifice to convert the opening to a slit like shape. The patients were followed up from 9 to 68 months.
Results: VUR was completely resolved in 72.7% (16) ureters following a single injection and in a further 4.5% (1) ureter following a second injection. 9.1% (2) ureters were improved and treatment failed in 13.7% (3) ureters. Two patients showed a recurrence of reflux 1 and 4 years after primary injection and subsequently had a curative second injection. Most of the patients in whom VUR was cured or improved showed a reduction in laboratory proven urinary infection rates.
Conclusion: Macroplastique® produced an excellent result (86% with complete resolution or improvement of reflux) in treating VUR in adult neuropathic bladders. This is comparable to larger studies carried out on the paediatric population. This is an easy procedure, which avoids major surgery and can be performed as a day case. In cases of failure or recurrence, repeat injection or open surgery can be undertaken without any added complications.
Spinal Cord (2001) 39, 92–96.
Similar content being viewed by others
Article PDF
References
Cosbie Ross J . Vesico-ureteric reflux in the neurogenic bladder Br J Urol 1965 52: 164
Talbot HS, Bunts RC . Late renal changes in paraplegia: Hydronephrosis due to vesico-ureteral reflux J Urol 1949 61: 810
Brereton RJ, Narayanan R, Ratnatunga C . Ureteric re-implantation in the neuropathic bladder Br J Surg 1987 74: 1107–1110
Goerdin A, Wyndaele JJ, De-Sy WA . Ureteroneocystostomy in the neuropathic bladder associated with high grade reflux Eur Urol 1991 20: 29–32
Matovsscek E . Die Behandlung des vesicorenalon refluxes durch transurethralen einspritzung von teflonpaste Urologe 1981 20: 263–266
Kaplan WE, Dalton DP, Firlit CF . The endoscopic correction of reflux by Polytetrafluoroethylene injection J Urol 1987 138: 935–955
Schulman CC et al. Vesicoureteral reflux in children: Endoscopic treatment Eur URol 1990 17: 314–317
Puri P . Ten year experience with subureteric TEFLON (polytetrafluoroethylene) injection (STING) in the treatment of vesico-ureteric reflux Br J Urol 1995 75: 126–131
Misra D, Potts SR, Brown S, Boston VE . Endoscopic treatment of vesico-ureteric reflux in neurogenic bladder – 8 years' experience J Paediat Surg 1996 31: 1262–1264
Sugiyama T et al. Endoscopic correction of vesicoureteral reflux in patients with neurogenic bladder dysfunction Int J Urol Nephrol 1995 27: 527–531
Puri P, Kumar R . Endoscopic correction of vesico-ureteral reflux secondary to posterior urethral valves J Urol 1996 156: 680–682
Miyakita H, Ninan GK, Puri P . Endoscopic correction of vesico-ureteral reflux in duplex systems Eur Urol 1993 24: 111–115
Foley SJ, Sheriff MK, Shah PJ . Endoscopic treatment of vesico-ureteric reflux in adults with a neuropathic bladder Spinal Cord 1996 34: 657–658
International Reflux Study Committee . Medical versus surgical treatment of primary vesicoureteral reflux Pediatrics 1981 67: 392–400
Puri P, O'Donnell B . Correction of experimentally produced vesicoureteric reflux in piglets by intravesical injection of Teflon BMJ 1984 289: 5–7
Puri P, Ninan GK, Surana R . Subureteric Teflon injection (STING): results of a European survey Eur Urol 1995 27: 71–75
Malizia Jr AA et al. Migration and granulomatous reaction after periurethral injection of polytef (teflon) JAMA 1984 251: 3277–3281
Lewy RB . Experience with vocal cord injection Ann Oto Rhinol Laryngol 1973 85: 440–450
Lockhart JL, Walker RD, Vorstman B, Politano VA . Periurethral polytetrafluoroethylene injection following urethral reconstruction in female patients with urinary incontinence J Urol 1988 140: 51
Dodat H et al. Analysis of the failure of endoscopic treatment of vesico-renal reflux in children using injections of Teflon and collagen and the preliminary results of injections of Macroplastique® Progrès en Urologie 1995 5: 58–68
Spiera H . Scleroderma after silicone augmentation mamoplasty JAMA 1986 260: 236–238
Varga J, Schumacher HR, Jimenez SA . Systemic sclerosis after augmentation mammoplasty with silicone implants Ann Intern Med 1989 111: 377–383
Silver RM et al. Demonstration of silicone in sites of connective tissue disease in patients with silicone-gel breast implants Arch Dermatol 1993 12: 63–68
Harriss DR, Jacovou JW, Lemberger RJ . Periurethral silicone microimplants (Macroplastique®) for the treatment of genuine stress incontinence Br J Urol 1996 78: 722–728
Beisang AA, Ersek RA . Mammalian response to subdermal implantation of textured microimplants Aesthetic Plast Surg 1992 16: 83–90
Tinkler JB, Campbell HJ, Senior JM, Ludgate SM . Evidence for an association between the implantation of silicones and connective tissue disease Medical Device Directorate (UK Department of Health) Report 1993 MDD/92/42 1–65
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Shah, N., Kabir, M., Lane, T. et al. Vesico-ureteric reflux in adults with neuropathic bladders treated with Polydimethylsiloxane (Macroplastique®). Spinal Cord 39, 92–96 (2001). https://doi.org/10.1038/sj.sc.3101090
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.sc.3101090