Original Research

Comparision of The Histologic Response to Different Bulking Materials Used in Endoscopic Vesicoureteral Reflux Surgery


  • Ali Cansu Bozacı
  • Fazıl Tuncay Aki
  • Dilara Zeybek
  • Sevda Müftüoğlu
  • Serdar Tekgül

Received Date: 14.06.2021 Accepted Date: 27.06.2021 J Urol Surg 0;0(0):0-0 [e-Pub]


To compare the histologic responses of 3 bulking agents, which are used in endoscopic treatment of vesicoureteral reflux (VUR), on rats’ urinary bladder and subcutaneous tissue.

Materials and Methods:

Thirty rats were divided into 3 groups according to the injection materials; Dextranomer Hyaluronic acid- Deflux®(DxHA-Df), Dextranomer Hyaluronic acid- Dexal®(DxHA-Dx) and Polyacrilate Polialcohol Copolymer-Vantris®(PPC). In each group material was injected both to the submucosa of rats’ urinary bladder dome and subcutaneous tissue at their napes. In each group, 5 rats were scarified at 2nd and 6th month of injection. The histopathologic comparement had done by scoring inflammation, neutrophil, eosinophil, macrophage, mast cell and giant cell reaction around the injected material.


All materials were maintained their bulky effect. Despite the big amount of degradation with dextranomer materials, there was minimal degradation with PPC. Materials had the same amount of capsule formation around the injection site, which was not related with the degradation property of the material. There was no statistically significant result for bladder injections. For subcutaneous injections mast cell scores around injection (DxHA-Df, DxHA-Dx, PPC: 1.4, 1.2, 0 respectively. p=0.024) were significantly different at 2nd month. Mast cell scores around injection (DxHA-Df, DxHA-Dx, PPC: 1.0, 1.75, 0 respectively. p=0.007) was significantly different at 6th month also. The inflammation around PPC was higher at 6th month (DxHA-Df, DxHA-Dx, PPC: 1, 1, 3.5 respectively. p<0.05).


Both dextranomer agents were degradable with good capsule formation and minimal inflammation at the adjacent tissue. PPC degraded minimally and caused significant inflammation at adjacent tissue.

Keywords: Vesicoureteral reflux, endoscopic treatment, injection materials