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Teflon — Polytetrafluoroethylene (PTFE / Polytef)

Polytef paste is a historical particulate bulking material used for urinary incontinence and subureteric treatment of vesicoureteral reflux (VUR). Its practical relevance is the assessment of patients who received it years or decades ago. Distant migration and foreign-body granulomas are the central safety concerns. The EAU 2026 pediatric guideline identifies migration as the reason PTFE has not been approved for use in children; favorable historical reflux-resolution rates do not make it a routine contemporary option.[1][2]

Historical Context​

Politano's group reported a 128-woman experience spanning 1964–1991. That makes PTFE an early synthetic urologic injectable, not proof it was the first material ever injected for incontinence. Matouschek published an endoscopic Teflon reflux treatment in 1981; Puri's later pediatric work developed a large experience with STING, subureteric Teflon injection.[3][4][5]

Injected particulate paste must be distinguished from solid or expanded PTFE products used for other purposes. Their performance and indications cannot be transferred to a periurethral or subureteric injection.

Material and Biological Response​

PTFE particles persist in tissue. Histological and experimental studies document dispersed particles, uptake within foreign-body reactions and migration away from the injection site. The description “non-immunogenic” does not mean absence of granulomatous inflammation.[2][6]

Particle size influenced later material design, but there is no universal size cutoff guaranteeing that every larger-particle agent cannot migrate. In particular, current Durasphere EXP differs from its original formulation, and homogeneous gels are not particulate materials.

What the Historical Outcomes Show​

EvidenceResultLimitation
Puri/Granata 1998 multicenter questionnaire8,332 children, 12,251 ureters across 41 centers; 9,226/12,251 (75.3%) resolved after one injection; further injections increased anatomical resolution. Obstruction requiring reimplantation occurred in 41 ureters.Survey-based follow-up, not randomized comparison or systematic screening for silent distant migration. Ureter counts are not patient-level infection or renal outcomes.[5]
Chertin 2002, long-term cohort258 children initially treated in 393 ureters; follow-up VCUG in 247 children/379 ureters found 360/379 (95%) without reflux at 11–17 years.Excludes initial reimplantation failures and missing imaging; not 95% success among all initially treated ureters.[7]
Yücel 2007, initially successful single injectionsOf 42 initially successful children, 38 with 48 ureters had long follow-up; 35/48 remained reflux-free, while 13/48 had recurrent reflux.Selected initial responders; cannot be directly ranked against an all-treated series or a different agent.[8]

Reported absence of recognized clinical adverse effects in a cohort cannot exclude microscopic migration, rare harm or later complications. Historical radiographic success alone does not establish prevention of febrile infection or renal scarring.

Female-incontinence cohorts also varied markedly. In a 46-woman series, 14 were dry; the reported 90% and 60% probabilities of remaining dry at one and two years applied to those 14 initial dry responders, not to the entire treated cohort. Such results should not be compared with modern all-patient cure rates.[9]

Migration and Granuloma Evidence​

Experimental Migration​

Malizia's 1984 animal study found PTFE at distant sites after periurethral injection in dogs and monkeys. At 50–70 days, particles were found in pelvic nodes in six of seven animals and lungs in four of seven; brain and kidneys were not studied at that early timepoint. At 10.5 months, particles were identified in nodes, lungs and brain in seven of seven animals, with granulomas at injection sites and some distant sites.[2]

A later experimental study also detected lung and brain particles after small bladder-wall injections. These experiments establish biological plausibility and a hazard signal, not the incidence of human neurological injury.[10]

Human Complications​

  • Pulmonary migration was documented in a clinical case after periurethral injection.[11]
  • In three children undergoing surgery after failed STING, all had particle-associated foreign-body reaction in pelvic nodes; one had a giant granuloma adherent to the ureter. The study did not find a giant ureteral granuloma in all three children.[6]
  • A teflonoma causing bladder-outlet obstruction nine years later was described after periurethral injections. Delayed complete obstruction has also been reported.[12][13]

These reports are clinically relevant possibilities, not population complication rates. They also refute a guarantee that an “inert” bulking material cannot cause troublesome local tissue responses.

Assessment of a Previously Treated Patient​

Obtain the original injection history when possible: agent, location, number of sessions and subsequent procedures. Consider retained material or granuloma when there is a periurethral mass, persistent pain, obstructive voiding, upper-tract dilation or an unexpected imaging finding. Evaluate infection, obstruction and other causes rather than attributing every abnormality to the old implant.

A selected long-term cohort found recurrent reflux associated with disappearance of the ultrasound-visible deposit. This supports investigating new infection or changes in imaging, but a visible mound is not a universal substitute for reflux assessment.[14]

Prior injection does not automatically prevent reconstruction, but tissue condition matters. In a small post-prostatectomy series, seven men later received an AUS without reported difficulty. That experience does not guarantee uncomplicated sling, AUS or ureteral surgery in every patient with fibrosis, obstruction or a symptomatic implant.[15]

See also: Historical Bulking Agents, Deflux, Urethral Bulking Agents.

References​

1. EAU. Paediatric Urology Guidelines. 2026, section 17.3.2a, bulking materials. Guideline.

2. Malizia AA, Reiman HM, Myers RP, et al. Migration and Granulomatous Reaction After Periurethral Injection of Polytef (Teflon). JAMA. 1984;251(24):3277-3281. PubMed.

3. Lopez AE, Padron OF, Patsias G, Politano VA. Transurethral Polytetrafluoroethylene Injection in Female Patients With Urinary Continence. The Journal of Urology. 1993;150(3):856-858. doi:10.1016/s0022-5347(17)35632-x

4. Matouschek E. Treatment of vesicorenal reflux by transurethral teflon-injection. Urologe A. 1981;20(5):263–264. PubMed.

5. Puri P, Granata C. Multicenter Survey of Endoscopic Treatment of Vesicoureteral Reflux Using Polytetrafluoroethylene. The Journal of Urology. 1998;160(3 Pt 2):1007-1011. doi:10.1097/00005392-199809020-00011

6. Aragona F, D'Urso L, Scremin E, Salmaso R, Glazel GP. Polytetrafluoroethylene Giant Granuloma and Adenopathy: Long-Term Complications Following Subureteral Polytetrafluoroethylene Injection for the Treatment of Vesicoureteral Reflux in Children. The Journal of Urology. 1997;158(4):1539-1542. doi:10.1016/s0022-5347(01)64275-7

7. Chertin B, Colhoun E, Velayudham M, Puri P. Endoscopic Treatment of Vesicoureteral Reflux: 11 to 17 Years of Followup. The Journal of Urology. 2002;167(3):1443-1445. doi:10.1016/s0022-5347(05)65340-2

8. Yücel S, Tarcan T, Simşek F. Durability of a Single Successful Endoscopic Polytetrafluoroethylene Injection for Primary Vesicoureteral Reflux: 14-Year Followup Results. The Journal of Urology. 2007;178(1):265-268. doi:10.1016/j.juro.2007.03.060

9. Herschorn S, Glazer AA. Early Experience With Small Volume Periurethral Polytetrafluoroethylene for Female Stress Urinary Incontinence. The Journal of Urology. 2000;163(6):1838-1842. PubMed.

10. Aaronson IA, Rames RA, Greene WB, et al. Endoscopic Treatment of Reflux: Migration of Teflon to the Lungs and Brain. European Urology. 1993;23(3):394-399. doi:10.1159/000474637

11. Claes H, Stroobants D, Van Meerbeek J, et al. Pulmonary Migration Following Periurethral Polytetrafluoroethylene Injection for Urinary Incontinence. The Journal of Urology. 1989;142(3):821-822. doi:10.1016/s0022-5347(17)38903-6

12. McKinney CD, Gaffey MJ, Gillenwater JY. Bladder Outlet Obstruction After Multiple Periurethral Polytetrafluoroethylene Injections. The Journal of Urology. 1995;153(1):149-151. doi:10.1097/00005392-199501000-00053

13. Boykin W, Rodriguez FR, Brizzolara JP, Thompson IM, Zeidman EJ. Complete Urinary Obstruction Following Periurethral Polytetrafluoroethylene Injection for Urinary Incontinence. The Journal of Urology. 1989;141(5):1199-1200. doi:10.1016/s0022-5347(17)41213-4

14. Oberritter Z, Somogyi R, Juhasz Z, Pinter AB. Role of the Teflon Deposit in the Recurrence of Vesicoureteral Reflux. Pediatric Nephrology. 2008;23(5):775-778. doi:10.1007/s00467-007-0725-6

15. Kabalin JN. Treatment of Post-Prostatectomy Stress Urinary Incontinence With Periurethral Polytetrafluoroethylene Paste Injection. The Journal of Urology. 1994;152(5 Pt 1):1463-1466. doi:10.1016/s0022-5347(17)32446-1