Dextranomer-hyaluronic acid injection safe, effective in vesicoureteral reflux treatment
Endoscopic injection of dextranomer/hyaluronic acid appears to safely and effectively eradicate high-grade vesicoureteral reflux (VUR), according to a study.
A total of 851 paediatric patients (median age 2.3 years) underwent endoscopic correction of high-grade VUR using dextranomer/hyaluronic acid. Reflux was unilateral in 415 patients and bilateral in 436. There were 1,287 refluxing units in the entire population: grade IV in 1,153 (89.6 percent) and grade V in 134 (10.4 percent). Results for 99mtechnetium-dimercaptosuccinic acid imaging showed renal scarring in 317 patients (37.3 percent).
Follow-up assessments included ultrasound and voiding cystourethrogram performed 3 months postintervention, and renal ultrasound annually thereafter. Median follow-up was 8.5 years.
Overall reflux resolution rate following the first endoscopic injection was 69.5 percent (70.4 percent in grade IV and 61.9 percent in grade V). Reflux resolved after a second injection in 20.1 percent and after a third in 10.4 percent. Persistent reflux after initial treatment occurred with greater frequency in infants <1 year and in cases with renal scarring.
There were no reports of significant postoperative complications, and no patient required ureteral reimplantation. However, following reflux resolution, 43 patients developed febrile urinary tract infections (UTIs). These infections occurred in the first year for 24 patients, in the second year for 15 and after ≥3 years for four.
In the group of patients who developed febrile UTIs, six had reflux recurrence and eight had neocontralateral grade III reflux, which was successfully resolved with a single endoscopic injection of dextranomer/hyaluronic acid.
Based on the present data, the researchers recommend use of endoscopic injection of dextranomer/hyaluronic, a minimally invasive outpatient procedure, in the first-line treatment of children with grade IV-V reflux. Of note, the procedure can be easily repeated in cases of failure with a high subsequent resolution rate.