A A Caldamone1, D A Diamond. 1. Division of Urology, Hasbro Children's Hospital, Brown University, Providence, Rhode Island, USA.
Abstract
PURPOSE: Endoscopic correction of vesicoureteral reflux continues to attract research of many autologous and nonautologous substances. We previously reported on the initial results of a clinical trial using endoscopic injection of autologous chondrocytes to correct vesicoureteral reflux in children and now present our greater than 1-year followup results. MATERIALS AND METHODS: A total of 29 children (47 ureters) with grades II to IV vesicoureteral reflux were treated at 2 centers. Each child underwent cystoscopy and posterior auricular cartilage harvesting at the initial setting. Chondrocytes were grown in culture during a 6-week period. Patients returned for transurethral injection of autologous chondrocytes into the ureterovesical junction of the refluxing ureters. Ultrasound was performed at 1 month, 1 year, and 2 and 3 years after implantation, and a voiding cystourethrogram or radionuclide cystogram at 3 months and 1 year after injection. If reflux persisted re-treatment with stored chondrocytes was offered. RESULTS: At 3-month followup initial chondrocyte injection corrected reflux in 55% of ureters (27 of 47) while a second or third injection was successful in additional 15 of 29 patients, resulting in an overall success rate of 86% (42 of 49) ureters and 25 of 29 patients. At 1-year followup reflux correction was maintained in 70% of ureters (32 of 46) and 65% of patients (19 of 29). The 1-year followup results after re-treatment of 3 ureters were not available. In those patients in whom implantation failed cystoscopy revealed evidence of volume loss and shifting of subureteral mounds to account for loss of the antireflux effect. Three patients underwent successful open ureteroneocystostomy for failed autologous chondrocyte implantation. There were no significant complications. CONCLUSIONS: Transurethral injection of autologous chondrocytes to correct vesicoureteral reflux in children is safe and reasonably effective. There is a relapse rate which must be considered. Changes in the formulation of the material have been made to enhance implant reliability and increase long-term success.
PURPOSE: Endoscopic correction of vesicoureteral reflux continues to attract research of many autologous and nonautologous substances. We previously reported on the initial results of a clinical trial using endoscopic injection of autologous chondrocytes to correct vesicoureteral reflux in children and now present our greater than 1-year followup results. MATERIALS AND METHODS: A total of 29 children (47 ureters) with grades II to IV vesicoureteral reflux were treated at 2 centers. Each child underwent cystoscopy and posterior auricular cartilage harvesting at the initial setting. Chondrocytes were grown in culture during a 6-week period. Patients returned for transurethral injection of autologous chondrocytes into the ureterovesical junction of the refluxing ureters. Ultrasound was performed at 1 month, 1 year, and 2 and 3 years after implantation, and a voiding cystourethrogram or radionuclide cystogram at 3 months and 1 year after injection. If reflux persisted re-treatment with stored chondrocytes was offered. RESULTS: At 3-month followup initial chondrocyte injection corrected reflux in 55% of ureters (27 of 47) while a second or third injection was successful in additional 15 of 29 patients, resulting in an overall success rate of 86% (42 of 49) ureters and 25 of 29 patients. At 1-year followup reflux correction was maintained in 70% of ureters (32 of 46) and 65% of patients (19 of 29). The 1-year followup results after re-treatment of 3 ureters were not available. In those patients in whom implantation failed cystoscopy revealed evidence of volume loss and shifting of subureteral mounds to account for loss of the antireflux effect. Three patients underwent successful open ureteroneocystostomy for failed autologous chondrocyte implantation. There were no significant complications. CONCLUSIONS: Transurethral injection of autologous chondrocytes to correct vesicoureteral reflux in children is safe and reasonably effective. There is a relapse rate which must be considered. Changes in the formulation of the material have been made to enhance implant reliability and increase long-term success.