Limitations and alternatives to endoscopic correction of vesicoureteral reflux with Polytef paste

Despite increased use with encouraging success rates, endoscopic correction of vesicoureteral reflux in children has persistent limitations. While many patients may be managed with this technique, a few with complete ureteral duplication or paraureteral diverticulum will not be successfully corrected. Nevertheless, precise placement of the implant beneath the ureteral orifice has resulted in success even in patients with highgrade reflux, patients with neuropathic bladder and in patients who have failed previous ureteroneocystostomy. Concern remains regarding the safety of the injectable Teflon substance, which elicits a local and distant foreign-body granuloma response. This has been noted in animal models and in a few human patients. Alternative substances such as glutaraldehyde cross-linked collagen and transplanted autologous fat may eliminate concern regarding the safety of the implant while preserving the excellent results reported with injectable Teflon.