Endoscopic treatment of vesicoureteral reflux in children with glutaraldehyde cross-linked bovine dermal collagen Short-term results

• Published in: Journal of Nippon Medical School Vol. 67; no. 1; pp. 9 - 12
• Main Authors: Tsuboi, Narumi, Horiuchi, Kazutaka, Osawa, Shuichi, Hamasaki, Tsutomu, Yoshida, Junko, Murakami, Mutsumi, Akimoto, Masao
• Format: Journal Article
• Language: English
• Published: Japan The Medical Association of Nippon Medical School 2000
• Subjects: Child; Child, Preschool; Collagen - administration & dosage; Cystoscopy; endoscopic treatment; Female; GAX collagen; Glutaral - pharmacology; Humans; Infant; Injections; Male; Pyelonephritis - prevention & control; Treatment Outcome; Vesico-Ureteral Reflux - complications; Vesico-Ureteral Reflux - therapy; VUR
• ISSN: 1345-4676; 1347-3409
• DOI: 10.1272/jnms.67.9

Background: Endoscopic treatment using glutaraldehyde cross-linked (GAX) collagen was conducted on 4 children with bilateral primary vesicoureteral reflux (VUR)…a 1-year-old boy and three 5- to 8-year-old girls…all having a history of repeated hospitalization for fever due to acute pyelonephritis, visiting as pediatric outpatients regularly and receiving antibiotics continuously. By international VUR classification, 4 ureters were grade 3, 2 grade 4, and 2 grade 5. Methods: After nonallergy to GAX collagen was confirmed intracutaneously, a needle was used through a 9.5 Fr cystoscope channel to puncture bladder mucosa 4 to 5 mm from the affected ureteral orifice at 6 o'clock under general anesthesia; 1.1 to 1.9 ml of GAX collagen was injected immediately below affected orifices. Results: Three months after surgery, voiding cystourethrography showed reflux had disappeared in 6 ureters, for a short-term success rate of 75%. VUR in the Remaining 2 ureters improved from grade 3 to 1 and from grade 5 to 4. No postoperative urinary tract infection occurred and antibiotics were stopped. Conclusion: Since GAX collagen is less viscous than Teflon paste, it is easily injected into sub-mucosa, does not from granuloma or migrate to other organs, and is noncarcinogenic. Endoscopic VUR treatment using GAX collagen is indicated when less invation and shorter hospitalization are considered, although it requires general anesthesia, which itself involves some risk. (J Nippon Med Sch 2000; 67: 9-12)