The Outcome of Endoscopic Subureteric Polyalcohol Copolymer Hydrogel (Vantris)Injection on Grade III -IV Primary Vesicoureteral Reflux for 5 years

Abstract

Background: The management of patients with vesicoureteral reflux (VUR) has been revolutionized with the introduction of the endoscopic injection of bulking agents, which is a minimally invasive, non-complex, time-saving procedure has a favorable outcome. Different synthetic and biologic injectable materials are now available. Studies regarding the effectiveness and outcomes of endoscopic injection of Vantris for endoscopic correction of primary VUR and there still a need for further studies in this topic. 
Objective: To evaluate the efficacy and safety of polyacrylate polyalcohol copolymer (Vantris) material in the endoscopic treatment of VUR patient after 5 years of prospective fellow up.
Patients and Methods: A prospective single group clinical trial conducted during the period 2020 – 2024. Prospectively included 48 patients (16 males, 32 females) who had primary VUR and treated by endoscopic Vantris injection and followed up for 5 years. Follow up assessment includes clinical examination and imaging (abdominal ultrasound and VUCG) at each scheduled follow up appointments (3 months, 12 months and 5 years) after first injection of Vantris.
Results: Age of the patients at initiation of treatment ranged between 3 months and 5 years with a median of 2 years. Females were dominant contributed for 62.5%. Grade III VUR was the more frequent (48.8%) and grade IV contributed for (36%). The injected volume of Vantris ranged between 0.4 to 1.2 ml. At the end of follow-up of 5 years, the final overall success rate was 91.9% of all RRUs, One patient (2.1%) had complicated with ureteral obstruction
Conclusions: Endoscopic injection of Vantris is effective and safe in the treatment of VUR among Iraqi pediatric patients producing high overall success rate of resolution of VUR of 91.9% of the RRUs and Very low complication rate. Therefore, we recommend using Endoscopic injection of Vantris as first option for treatment of VUR of grade II to IV among pediatric Iraqi patients. And further studies with larger sample size preferably multicenter are highly suggested.