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Endoscopic injection of dextranomer/hyaluronic acid safe, effective in high-grade vesicoureteral reflux

08 Sep 2018

A recent study has shown the efficiency and safety of endoscopic injection of dextranomer/hyaluronic acid as long-term treatment for grade IV and V vesicoureteral reflux. Moreover, it can easily be repeated in patients with treatment failure with a high subsequent resolution rate.

Overall, there was a 69.5-percent resolution rate after the first endoscopic injection (70.4 percent and 61.9 percent of grade IV and V cases, respectively). Reflux resolved in 259 (20.1 percent) and 133 (10.4 percent) patients after a second and third injection, respectively.

Patients aged <1 year and those with renal scarring were at higher odds of persistent reflux after initial treatment. There were no significant postoperative complications, and no patient needed ureteral reimplantation.

Febrile urinary tract infection occurred in 43 children (5.1 percent) after reflux resolution, including 24 (55.8 percent) during the first year, 15 (34.9 percent) during the second year and four (9.3 percent) during year 3 or later. Of these, six had reflux recurrence and eight had neocontralateral grade III reflux, which was resolved with a single endoscopic injection of dextranomer/hyaluronic acid.

The study included 518 girls and 333 boys (median age 2.3 years; range, 2 months to 13.7 years) who underwent endoscopic correction of high-grade vesicoureteral reflux using dextranomer/hyaluronic acid. Reflux was unilateral and bilateral in 415 and 436 patients, respectively, comprising 1,287 refluxing units. Reflux was grade IV and V in 1,153 (89.6 percent) and 134 (10.4 percent) ureters, respectively.

Renal scarring was identified in 317 patients (37.3 percent) using 99mtechnetium-dimercaptosuccinic acid scintigraphy. Follow-up ultrasound and voiding cystourethrogram were conducted 3 months after intervention and renal ultrasound yearly afterwards. Median follow-up was 8.5 years (range, 6 months to 16 years).

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