Endoscopic treatment of vesicoureteral reflux with dextranomer/hyaluronic acid copolymer is effective in either double ureters or a small kidney.

Abstract

PURPOSE:

Endoscopic injection of dextranomer/hyaluronic acid (Dx/HA) copolymer is an increasingly established treatment for primary vesicoureteral reflux (VUR) in children. We performed a retrospective analysis to assess this treatment for VUR associated with either double ureters or a small kidney.

MATERIALS AND METHODS:

The study included 68 children with duplex ureters and 40 with a small kidney (1 kidney contributing 10% to 35% of total renal function) who underwent endoscopic treatment with Dx/HA copolymer for VUR. Followup consisted of voiding cystourethrography 3 and 12 months after injection. Positive response was defined as reflux grade 0 or I. As many as 2 repeat injections were offered to nonresponders, and those with persistent reflux were referred for open surgery. Long-term clinical followup with renal function testing was continued for 4 to 9 years.

RESULTS:

A positive response was observed in 63% of children with duplex ureters, with only 17 (25%) patients requiring open surgery. Among children with a small kidney the response rate was 70%, and open surgery was performed in 9 (23%). In both treatment groups a positive response to treatment was sustained throughout the followup period in all cases. The treatment was well tolerated, with no complications associated with the procedure.

CONCLUSIONS:

Endoscopic treatment with Dx/HA copolymer appears to be an effective and well tolerated alternative to open surgery for first line treatment of VUR associated with double ureters or a small kidney.

• Authors: Göran Läckgren, Nils Wåhlin, Erik Sköldenberg, Tryggve Nevéus, Arne Stenberg
• Journal: The Journal of urology (J Urol) Vol. 170 Issue 4 Pt 2 Pg. 1551-5; discussion 1555 (Oct 2003) ISSN: 0022-5347 [Print] United States
• PMID: 14501658 (Publication Type: Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Dextrans
• deflux
• Hyaluronic Acid

Topics

• Administration, Intravesical
• Child
• Child, Preschool
• Dextrans (administration & dosage)
• Female
• Follow-Up Studies
• Humans
• Hyaluronic Acid (administration & dosage)
• Infant
• Kidney (abnormalities)
• Male
• Prosthesis Implantation
• Retrospective Studies
• Treatment Outcome
• Ureter (abnormalities)
• Vesico-Ureteral Reflux (congenital, physiopathology, therapy)