Dextranomer/hyaluronic acid endoscopic injection is effective in the treatment of intermediate and high grade vesicoureteral reflux in patients with complete duplex systems.

Abstract

PURPOSE:

Endoscopic subureteral injection of dextranomer/hyaluronic acid has become an established alternative to long-term antibiotic prophylaxis or surgical treatment for vesicoureteral reflux. We evaluated the effectiveness of endoscopic injection of dextranomer/hyaluronic acid in intermediate and high grade vesicoureteral reflux in patients with complete duplex collecting systems.

MATERIALS AND METHODS:

A total of 123 children underwent endoscopic correction of intermediate or high grade vesicoureteral reflux using injection of dextranomer/hyaluronic acid into complete duplex systems between 2001 and 2010. Vesicoureteral reflux was diagnosed by voiding cystourethrogram, and dimercapto-succinic acid scan was performed to evaluate the presence of renal scarring. Followup ultrasound and voiding cystourethrogram were performed 3 months after the outpatient procedure and renal ultrasound thereafter every 2 years. Mean followup was 6.7 years.

RESULTS:

Complete duplex systems were unilateral in 110 patients and bilateral in 13. Reflux severity in the 136 refluxing units was grade II in 1 (0.7%), III in 52 (38.2%), IV in 61 (44.9%) and V in 22 (16.2%). Dimercapto-succinic acid scan revealed renal functional abnormalities in 63 children (51.2%). Vesicoureteral reflux resolved after the first endoscopic injection of dextranomer/hyaluronic acid in 93 ureters (68.4%), after a second injection in 35 (25.7%) and after a third injection in 8 (5.9%). Febrile urinary tract infection developed in 5 patients (4.1%) during followup. No patient required ureteral reimplantation or experienced significant complications.

CONCLUSIONS:

Our results confirm the safety and efficacy of endoscopic injection of dextranomer/hyaluronic acid in eradicating intermediate and high grade vesicoureteral reflux in patients with complete duplex systems. We recommend this minimally invasive, 15-minute outpatient procedure as a viable option for treating intermediate and high grade vesicoureteral reflux in patients with complete duplex collecting systems.

• Authors: Manuela Hunziker, Nochiparambil Mohanan, Prem Puri
• Journal: The Journal of urology (J Urol) Vol. 189 Issue 5 Pg. 1876-81 (May 2013) ISSN: 1527-3792 [Electronic] United States
• PMID: 23159268 (Publication Type: Journal Article)
• Copyright: Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Chemical References

• Dextrans
• dextranomer-hyaluronic acid copolymer
• Hyaluronic Acid

Topics

• Abnormalities, Multiple
• Child
• Child, Preschool
• Dextrans (administration & dosage)
• Endoscopy
• Female
• Humans
• Hyaluronic Acid (administration & dosage)
• Infant
• Injections (methods)
• Kidney (abnormalities)
• Male
• Retrospective Studies
• Severity of Illness Index
• Ureter (abnormalities)
• Vesico-Ureteral Reflux (complications, therapy)