Relative contraindication to endoscopic subureteral injection for vesicoureteral reflux: congenital refluxing megaureter with distal aperistaltic segment.

Urology 2008 Apr 4;71(4):616-9; discussion 619-20. Epub 2008 Mar 4.

Department of Urology, University of California, San Francisco, School of Medicine, San Francisco, California 94117, USA.

Objectives: Endoscopic subureteral injection for the management of vesicoureteral reflux has become a well-established first-line minimally invasive treatment strategy. One potential pitfall is the creation of ureteral obstruction. No predictors are available to determine which patients will develop this rare, but real, complication.

Methods: A retrospective evaluation of 2 girls, aged 3 and 4 years, with grade 4 and 3 reflux, respectively, and documented ureteral obstruction after endoscopic treatment with dextranomer/hyaluronic acid copolymer. Before treatment, both patients had had refluxing megaureters with a distal aperistaltic segment.

Results: Ultimately, they both required open, cross-trigonal ureteral reimplantation with resolution of vesicoureteral reflux and ureteral obstruction.

Conclusions: Congenital refluxing megaureter with a distal aperistaltic segment might be a relative contraindication to endoscopic subureteral injection of a bulking agent for the management of vesicoureteral reflux.

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http://dx.doi.org/10.1016/j.urology.2007.11.086DOI Listing
April 2008
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