4. The history of injection therapy of vesicoureteric reflux
Göran Läckgren MD PhD,
Professor of Pedaitric Urology, University Children´s Hospital , Uppsala Sweden
The first work on the endoscopic injection therapy of vesicoureteral reflux (VUR) was published by Matouscheck in 1981 : “Die Behandlung des vesikorenalen Refluxes durch transurtehrale Entspritzung von Teflon Paste” (Urologe A) . However, even earlier this idea was brought up by Victor Politano (J Urol, 1974) , who introduced teflon injection for the treatment on urinary incontinence, when he mentionned that subureteral injection of teflon may be used to cure VUR.
The pioneer, experimental and clinical work by Barry O´Donnell and Prem Puri on teflon injection was published in 1984 and made this treatment popular among pediatric urologists/surgeons over the world. Since then the endoscopic correction of VUR has proved to be a successful, minimally invasive treatment.
In the 1990-ties increased concern was raised against the use of Teflon based on a risk for small particle migration to other organs. Polydimethylsiloxane (Macroplastique) , that contained larger particles seemed to be a good alternative, but distant particle migration have been seen even after silicone injection. There are also other non-biological materials as Calcium hydroxyapatite in use today.
Because of the potential risk for migration and life-long persistence of these substances more biological materials came into use . Bovine Collagen was used for long time , but with less successrate and a higher recurrence rate and is now more or less abandonned. Chondrocytes was injected , but the complex procedure of this method prevented it from routine use.
The search for new “biological” material continued during the 90-ties and in 1994 the first presentation of a new material ,Dextranomers in Hyaluronic Acid (Deflux®) was made in “Dialogues of Ped Urology “ . Particularily after the approval by FDA in 2001, Deflux® has been the substance of choice for the endoscopic treatment. The technical improvement of the treatment over the last decade (Kirsch et al.) have increased the successrate and many publications have demonstrated this in most grades and types of VUR . The endoscopic treatment may therefore often be a first- choice treatment to avoid long-term antibiotic prophylaxis and is, thus, an established treatment of most children with urinary tract infection and VUR.