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Treatment of Pediatric Vesicoureteral Reflux Using Endoscopic Injection of Hyaluronic Acid/Dextranomer Gel: Intermediate-term Experience by a Single Surgeon

Treatment of Pediatric Vesicoureteral Reflux Using Endoscopic Injection of Hyaluronic Acid/Dextranomer Gel: Intermediate-term Experience by a Single Surgeon

Authors :
Michael H. Hsieh
David R. Roth
Ramiro Madden-Fuentes
Nicholas E. Lindsay
Source :
Urology. 76:199-203
Publication Year :
2010
Publisher :
Elsevier BV, 2010.

Abstract

Objectives Endoscopic injection of non–animal-stabilized hyaluronic acid/dextranomer gel is an increasingly recognized treatment option for vesicoureteral reflux. The procedure is minor compared with open surgery and, when successful, avoids the need for long-term antibiotic prophylaxis. We present data from 3 years of using non–animal-stabilized hyaluronic acid/dextranomer gel to treat children with vesicoureteral reflux. Methods Pediatric patients aged 16 years with uncomplicated primary vesicoureteral reflux were recruited for endoscopic treatment with non–animal-stabilized hyaluronic acid/dextranomer gel. A follow-up voiding cystourethrogram was scheduled at 2 weeks after treatment, and vesicoureteral reflux resolution was defined as grade 0. Repeat non–animal-stabilized hyaluronic acid/dextranomer gel treatment was offered to patients with persistent vesicoureteral reflux. Results Of 178 patients treated, 12 were lost to follow-up or yet to undergo post-treatment voiding cystourethrogram. The 166 remaining patients (efficacy population) had a mean age of 4.21 years (range: 0-16), and the median reflux grade was 3 (range: 1-5). Vesicoureteral reflux was resolved in 81.9% of patients and 86.4% of ureters after initial endoscopic treatment with non–animal-stabilized hyaluronic acid/dextranomer gel. The overall reflux resolution rate for patients increased to 89.6% after a second treatment in 19 patients, and 90.2% after a third treatment in 1 patient. No adverse events were reported. Five patients underwent open ureteral reimplantation after failed endoscopic injections. Conclusions Endoscopic treatment with non–animal-stabilized hyaluronic acid/dextranomer gel is effective in a high proportion of children with vesicoureteral reflux and, in our opinion, should be considered as a first-line treatment option.

Details

ISSN :
00904295
Volume :
76
Database :
OpenAIRE
Journal :
Urology
Accession number :
edsair.doi.dedup.....ca330e3107112965fb80247f0ca3a490
Full Text :
https://doi.org/10.1016/j.urology.2009.10.034