Endoscopic subureteral polydimethylsiloxane injection and prevention of recurrent acute graft pyelonephritis

Background/Aims: Vesicoureteral reflux (VUR) is an important factor in recurrent acute graft pyelonephritis (AGPN). In this study, we evaluated the effect of subureteral polydimethylsiloxane (PDS) injection on recurrent AGPN in renal transplant recipients with VUR. Methods: 64 renal transplant recipients with recurrent AGPN were included, 31 (48%) of whom had VUR. Of the patients with VUR, 19 (61%) were treated with PDS and the others were managed with antibiotics. The effect of PDS treatment on recurrent AGPN was evaluated in terms of the overall success rate, the success rate according to VUR grade, and the number of PDS treatments. Results: The overall success rate of PDS injection was 63%, and the number of AGPN episodes was significantly reduced after injection compared with the number before injection (0.21 vs. 1.34 times/person-year, respectively, p < 0.05). The success rate of PDS treatment differed with the VUR grade (50% in grade 1, 33% in grade 2, 75% in grade 3, and 67% in grade 4). The success rate in the first trial was 67% and in the second it was 50%. Conclusion: PDS injection is an effective treatment for recurrent AGPN in renal allograft recipients with VUR.