POLYACRYLATE POLYALCOHOL COPOLYMER (VANTRIS®) AS AN OPTION FOR MINIMALLY INVASIVE MANAGEMENT OF VESICOURETERAL REFLUX: OUR EXPERIENCE
Abstract
Minimally invasive treatment of vesicoureteral reflux (VUR) has gained popularity in recent decades for numerous advantages of the procedure itself: easy to perform, short inpatient care time compared to open techniques, a rare occurrence of serious complications, and short duration of stay in hospital. There are two groups of injectable tissue augmentation agents: biodegradable and non-biodegradable. Vantris® is a combination of two groups.
The aim of the study was to determine the effectiveness of Vantris® as an option in the minimally invasive treatment of VUR.
We conducted a prospective study for a period of five years (2015−2019). A total of 24 patients, or 39 renal reflux units (RRJ) were treated with Vantris®.
Reflux was unilateral in 9 patients (37.5%), and bilateral in 15 patients (62.5%). Reflux grade was V in two ureters (5.12%), IV in 6 ureters (15.38%), III in 22 (56.42%), II in three (7.69%) and I in 6 (15.38%). Median follow-up was 12 months and included urinalysis, urinary tract ultrasound, and voiding cystoureterography at one year. Reflux was eliminated in 36 ureters (92.31%). Two patients developed ureterovesical junction obstruction, while one patient required another injection treatment.
Vantris® can be used to treat VUR successfully and with a low percentage of complications. The application is simple, the rate of complications is reduced to a minimum, and therefore it could become the treatment of choice for the treatment of VUR.
References
Banker H, Aeddula NR. Vesicoureteral Reflux. [Updated 2022 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. [PubMed]
Chertin B, Arafeh WA, Zeldin A, Kocherov S. Preliminary data on endoscopic treatment of vesicoureteric reflux with polyacrylate polyalcohol copolymer (Vantris®): surgical outcome following single injection. J Pediatr Urol 201;7(6):654-7. [CrossRef] [PubMed]
Chertin B, Kocherov S, Chertin L, Natsheh A, Farkas A, Shenfeld OZ, et al. Endoscopic bulking materials for the treatment of vesicoureteral reflux: a review of our 20 years of experience and review of the literature. Adv Urol 2011;2011:309626. [CrossRef] [PubMed]
Chertin B, Natsheh A, Fridmans A, Shenfeld OZ, Farkas A. Renal scarring and urinary tract infection after successful endoscopic correction of vesicoureteral reflux. J Urol 2009;182(4 Suppl):1703-6. [CrossRef] [PubMed]
Chung KLY, Sihoe J, Liu K, Chao N, Hung J, Liu C, et al. Surgical Outcome Analysis of Pneumovesicoscopic Ureteral Reimplantation and Endoscopic Dextranomer/Hyaluronic Acid Injection for Primary Vesicoureteral Reflux in Children: A Multicenter 12-Year Review. J Laparoendosc Adv Surg Tech A 2018;28(3):348-53. [CrossRef] [PubMed]
Dothan D, Kocherov S, Jaber J, Chertin B. Endoscopic Correction of Reflux Utilizing Polyacrylate Polyalcohol Bulking Copolymer (Vantris) as a Tissue Augmenting Substance: Lessons Learned Over the 10 Years of Experience. J Laparoendosc Adv Surg Tech A 2021; 31(9):1073-78. [CrossRef] [PubMed]
Elder JS, Diaz M, Caldamone AA, Cendron M, Greenfield S, Hurwitz R, Kirsch A, Koyle MA, Pope J, Shapiro E. Endoscopic therapy for vesicoureteral reflux: a meta-analysis. I. Reflux resolution and urinary tract infection. J Urol 2006;175(2):716-22. [CrossRef] [PubMed]
Kalisvaart JF, Scherz HC, Cuda S, Kaye JD, Kirsch AJ. Intermediate to long-term follow-up indicates low risk of recurrence after Double HIT endoscopic treatment for primary vesico-ureteral reflux. J Pediatr Urol 2012;8(4):359-65. [CrossRef] [PubMed]
Kocherov S, Ulman I, Nikolaev S, Corbetta JP, Rudin Y, Slavkovic A, et al. Multicenter survey of endoscopic treatment of vesicoureteral reflux using polyacrylate-polyalcohol bulking copolymer (Vantris). Urology 2014; 84(3):689-93. [CrossRef] [PubMed]
Lee EK, Gatti JM, Demarco RT, Murphy JP. Long-term followup of dextranomer/hyaluronic acid injection for vesicoureteral reflux: late failure warrants continued followup. J Urol 2009;181(4):1869-74; discussion 1874-5. [CrossRef] [PubMed]
Lopez PJ, Celis S, Reed F, Zubieta R. Vesicoureteral reflux: current management in children. Curr Urol Rep 2014;15(10):447. [CrossRef] [PubMed]
O'Donnell B, Puri P. Treatment of vesicoureteric reflux by endoscopic injection of Teflon. Br Med J (Clin Res Ed) 1984;289(6436):7-9. [CrossRef] [PubMed]
Ormaechea M, Paladini M, Pisano R, Scagliotti M, Sambuelli R, Lopez S, et al. Vantris, a biocompatible, synthetic, non-biodegradable, easy-to-inject bulking substance. Evaluation of local tissular reaction, localized migration and long-distance migration. Arch Esp Urol 2008;61(2):263-8. [CrossRef] [PubMed]
Ormaechea M, Ruiz E, Denes E, Gimenez F, Dénes FT, Moldes J, et al. New tissue bulking agent (polyacrylate polyalcohol) for treating vesicoureteral reflux: preliminary results in children. J Urol 2010;183(2):714-7. [CrossRef] [PubMed]
Sargent MA. What is the normal prevalence of vesicoureteral reflux? Pediatr Radiol 2000;30(9):587-93. [CrossRef] [PubMed]
