During the last 25years, endoscopic correction of vesicoureteral reflux (VUR) has become a well-recognized procedure. However, the nature of the bulking agent used has led to many controversies. The objective of this work was to perform a literature review on the use of polydimethylsiloxane (PDMS or Macroplastique) in VUR.
A PubMed review of the literature since 1996 resulted in the selection of 24 studies of sufficient level of evidence to assess the efficacy and tolerance of Macroplastique in the VUR in adults and children.
The overall success rate at 1 year, 2 years and 9-years follow-up was respectively 86-93 %, 80-92 %, and 77-100 %, which confirms the maintenance of good results over time, notably in VUR grade III and above. The success rate was similar for primary and secondary VUR except for total duplicity. Predictive criterias of success were the surgeon's experience, the low grade of VUR, and the absence of previous injection. In comparison with other bulking agents, the higher viscosity and absence of shrinkage of the product increase its reliability. After more than 12 years of use, no serious complication has been reported in the literature, reflecting the good tolerance of Macroplastique on the long term.
The studies published on the use of Macroplastique in VUR confirmed its efficacy, around 85 % of success for all grades, in children and adults as well. The interest of PDMS is linked to its higher viscosity promoting a better reliability and reproducibility of the technique and its non-resorbable nature providing a permanent result, especially valuable in high-grade VUR with anatomical anomaly of the vesicoureteral junction or in VUR secondary to permanent lower urinary tract dysfunction.
Source: PubMed 20380986