Late Presentation of Ureterovesical Junction Obstruction after Submucosal Transurethral Injection of Dextranomer/Hyaluronic Acid Copolymer for Vesicoureteral Reflux

Abstract

Objective – We report a case of late-presenting symptomatic ureterovesical junction obstruction after endoscopic treatment of low grade vesicoureteral reflux.

Case report – A two-year old girl, with no other underlying conditions, underwent endoscopic Submucosal Transurethral Injection of one ml dextranomer/hyaluronic acid copolymer for grade three VUR on the right side. She recovered uneventfully and remained asymptomatic for one year, when she presented with right-side flank pain. Renal ultrasound showed hydronephrosis with calyceal dilatation and hydroureter. Ureterovesical junction obstruction caused by the bulking agent was suspected on MR urography. A large 2×2 cm mass was found extravesically, clearly obstructing the ureter. After excision of the mass and reimplantation of the ureter, the hydronephrosis settled.

Conclusion – However rare it is, ureterovesical obstruction may develop after endoscopic submucosal transurethral injection of dextranomer/hyaluronic acid copolymer. Long-term postoperative follow up may be necessary.