International Urology and Nephrology

, Volume 39, Issue 2, pp 417–420 | Cite as

Endoscopic subureteral injection treatment with calcium hydroxylapatite in primary vesicoureteral reflux

  • Bilal Eryıldırım
  • Fatih Tarhan
  • Uğur Kuyumcuoğlu
  • Erkan Erbay
  • Gökhan Faydacı
Original Paper



In this study, we aimed to evaluate efficiency of subureteral injection of calcium hydroxylapatite treatment for primary vesicoureteral reflux (VUR).

Materials and methods

A total of 25 children (mean age 6.9 ± 2.7 years) underwent subureteral injection of calcium hydroxylapatite for primary VUR. Reflux was present in 39 ureteral units that were unilateral in 11 cases and bilateral in 14 cases. According to “International Reflux Classification”; grade II in 12 (30.8%), grade III in 18 (46.2%) and grade IV in 9 (23.1%) ureteral units were found.


The refluxes were resolved in 23 (59.0%) ureteral units after a single injection and 5 ureteral units (12.8%) after a second injection. Overall success rate of reflux treatment with calcium hydroxylapatite was 71.8% in all ureteral units.


Endoscopic subureteral injection of calcium hydroxylapatite in children with primary low-grade VUR appears to be an effective, safe and minimally invasive technique.


Calcium hydroxylapatite Endoscopic Injection Vesicoureteral reflux 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Atala A, Keating MA (2002) Vesicoureteral Reflux and Megaureter. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ (eds). Campbell’s urology. Saunders Co., Philadelphia, 2053–2116Google Scholar
  2. 2.
    Bailey RR, Maling TMJ, Swainson CP (1993) Vesicoureteral reflux and reflux nephropathy. In: Schrier RW, Gottschalk CW (eds). Diseases of the kidney. Little, Brown & Co., Boston 689–727Google Scholar
  3. 3.
    Abrams P, Mayer RD, Lawrence W, Hubbard WG (2002) Long-term clinical experience with Coaptite urological bulking agent. Eur Urol (S1): 618 (abstract)Google Scholar
  4. 4.
    Mayer R, Lightfoot M, Jung I (2001) Preliminary evaluation of calcium hydroxylapatite as a transurethral bulking agent for stress urinary incontinence. Urology 57:434–438Google Scholar
  5. 5.
    Trsinar B, Cotic D, Oblak C (1999) Possible causes of unsuccessful endoscopic collagen treatment of vesicoureteric reflux in children. Eur Urol 36:635–639Google Scholar
  6. 6.
    Puri P, Chertin B, Velayudham M et al (2003) Treatment of vesicoureteral reflux by endoscopic injection of dextranomer/hyaluronic acid copolymer: preliminary results. J Urol 170:1541–1544PubMedCrossRefGoogle Scholar
  7. 7.
    Puri P (1995) Ten-year experience with subureteric Teflon (polytetraflouroethylene) injection (STING) in the treatment of vesicoureteral reflux. Br J Urol 75:126–131PubMedGoogle Scholar
  8. 8.
    Merckx L, De Boe V, Braeckman J, et al (1995) Endoscopic submucosal Teflon injection (STING): an alternative treatment of vesicoureteral reflux in children. Eur J Pediatr Surg 5:34–36PubMedCrossRefGoogle Scholar
  9. 9.
    Penco JMM, Fraile AG, Alarcon JR (2004) Evolution of the treatment of vesicoureteral reflux in Spain. J Urol 171:834–837CrossRefGoogle Scholar
  10. 10.
    Kershen RT, Atala A (1999) New advances in injectable therapies for the treatment of incontinence and vesicoureteral reflux. Urol Clin North Am 26:81–94PubMedCrossRefGoogle Scholar
  11. 11.
    Haferkamp A, Contractor H, Mohring K, et al (2000) Failure of subureteral bovine collagen injection for the endoscopic treatment of primary vesicoureteral reflux in long-term follow-up. Urology 55:759–763PubMedCrossRefGoogle Scholar
  12. 12.
    Leonard MP, Decter A, Hills K, et al (1998) Endoscopic subureteral collagen injection: are immunological concerns justified?. J Urol 160:1012–1016PubMedCrossRefGoogle Scholar
  13. 13.
    Caldamone AA, Diamond DA (2001) Long-term results of the endoscopic correction of vesicoureteral reflux in children using autologous chondrocytes. J Urol 165:2224–2227PubMedCrossRefGoogle Scholar
  14. 14.
    Al-Hunayan AA, Kehinde EO, Elsalam MA, et al (2002) Outcome of endoscopic treatment for vesicoureteral reflux in children using polydimethylsiloxane. J Urol 168:2181–2183PubMedCrossRefGoogle Scholar
  15. 15.
    Oswald J, Riccabona M, Lusuardi L, et al (2002) Prospective comparison and one-year follow-up of a single endoscopic subureteral polydimethylsiloxane versus dextranomer/hyaluronic acid copolymer injection for treatment of vesicoureteral reflux in children. Urology 60:894–897PubMedCrossRefGoogle Scholar
  16. 16.
    Chertin B, Puri P (2002) Endoscopic management of vesicoureteral reflux: does it stand the test of time?. Eur Urol 42:598–606PubMedCrossRefGoogle Scholar
  17. 17.
    Mevorach R, Rabinowitz R, Beck C et al. (2002) Endoscopic treatment of vesicoureteral reflux with Coaptite®: The first 50 patients. J Urol 167: 429 (abstract)Google Scholar
  18. 18.
    Puri P, Granata C (1998) Multicenter survey of endoscopic treatment of vesicoureteral reflux using polytetraflouroethylene. J Urol 160:1007–1011PubMedCrossRefGoogle Scholar
  19. 19.
    Chertin B, De Caluwe D, Puri P (2003) Endoscopic treatment of primary grades IV and V vesicoureteral reflux in children with subureteral injection of polytetraflouroethylene. J Urol 169:1847–1849PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  • Bilal Eryıldırım
    • 1
    • 2
  • Fatih Tarhan
    • 1
  • Uğur Kuyumcuoğlu
    • 1
  • Erkan Erbay
    • 1
  • Gökhan Faydacı
    • 1
  1. 1.Dr Lütfi Kirdar Kartal Training and Research HospitalIstanbulTurkey
  2. 2.Atalat Cad. Yakutlar SitesiKartal İstanbulTurkey

Personalised recommendations