Relative Contraindication to Endoscopic Subureteral Injection for Vesicoureteral Reflux: Congenital Refluxing Megaureter with Distal Aperistaltic Segment

ObjectivesEndoscopic subureteral injection for the management of vesicoureteral reflux has become a well-established first-line minimally invasive treatment strategy. One potential pitfall is the creation of ureteral obstruction. No predictors are available to determine which patients will develop this rare, but real, complication.MethodsA retrospective evaluation of 2 girls, aged 3 and 4 years, with grade 4 and 3 reflux, respectively, and documented ureteral obstruction after endoscopic treatment with dextranomer/hyaluronic acid copolymer. Before treatment, both patients had had refluxing megaureters with a distal aperistaltic segment.ResultsUltimately, they both required open, cross-trigonal ureteral reimplantation with resolution of vesicoureteral reflux and ureteral obstruction.ConclusionsCongenital refluxing megaureter with a distal aperistaltic segment might be a relative contraindication to endoscopic subureteral injection of a bulking agent for the management of vesicoureteral reflux.