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Dextranomer-hyaluronic acid injection safe, effective in vesicoureteral reflux treatment

13 Apr 2018

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.

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Most Read Articles
Tristan Manalac, 6 days ago
Atopic dermatitis appears to impair sleep quality, but not sleep duration, in children, particularly in those with more severe diseases, according to a new study.
13 Mar 2019
Individuals following a diet low in or free of meat are at lower risk of diabetes, and this protective association is partly attributable to having a lower body mass index when compared with regular meat eaters, according to a study.
4 days ago
Drinking coffee confers benefits for recurrence of hepatocellular carcinoma (HCC) and survival following orthotopic liver transplantation, a study has found.
13 Mar 2019
Vitamin E supplementation does not appear to contribute to blood pressure (BP) improvement, with results of a recent systematic review and meta-analysis showing decreases only in systolic (S)BP but no favourable effect on diastolic (D)BP and mean arterial pressure (MAP).