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• W1972256479 abstract "No AccessJournal of UrologyReflux1 Oct 2004ENDOSCOPIC TREATMENT WITH DEXTRANOMER/HYALURONIC ACID FOR COMPLEX CASES OF VESICOURETERAL REFLUX MARCOS PEREZ-BRAYFIELD, ANDREW J. KIRSCH, TERRY W. HENSLE, MARTIN A. KOYLE, PETER FURNESS, and HAL C. SCHERZ MARCOS PEREZ-BRAYFIELDMARCOS PEREZ-BRAYFIELD More articles by this author , ANDREW J. KIRSCHANDREW J. KIRSCH Financial interest and/or other relationship with Q-Med More articles by this author , TERRY W. HENSLETERRY W. HENSLE Financial interest and/or other relationship with Q-Med More articles by this author , MARTIN A. KOYLEMARTIN A. KOYLE Financial interest and/or other relationship with Bayer, Mentor, Q-Med, Alza and Cook More articles by this author , PETER FURNESSPETER FURNESS Financial interest and/or other relationship with Q-Med More articles by this author , and HAL C. SCHERZHAL C. SCHERZ More articles by this author View All Author Informationhttps://doi.org/10.1097/01.ju.0000139013.00908.1cAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The surgical correction of primary vesicoureteral reflux (VUR) is highly successful. This success decreases in more complex cases and often involves reoperation and increased morbidity. We present our experience with the use of subureteral injection of dextranomer/hyaluronic acid (Dx/HA) in complex cases of vesicoureteral reflux in which open surgery would have been indicated. Materials and Methods: Between October 2001 and July 2003, 72 patients 9 months to 31 years old (mean age 5.6 years) underwent subureteral injection of Dx/HA for complex VUR at our institutions. Dx/HA was injected submucosally within the intramural ureter (modified STING) in most cases. A guidewire was used to manipulate the ureteral orifice and a retrograde ureterogram was used to delineate the anatomy in selected cases. The average volume of injected material was measured for each ureter. Renal sonography was performed to determine if hydronephrosis was present. At 3 months fluoroscopic voiding cystourethrograms were used to evaluate for the presence of VUR. Results: A total of 93 ureters were treated in 55 girls and 17 boys. All cases were considered to be complex as 17 had persistent reflux after open surgery (7 megaureters repairs, 2 extravesical repairs, 7 intravesical reimplants and 1 blind ureter), 11 had persistent reflux and neurogenic bladder, 7 had ectopic ureters to bladder neck, 6 had bilateral Hutch diverticulum, 6 had persistent stump reflux, 5 had ureterocele after puncture or incision, 15 had duplications, 1 had the prune belly syndrome, 2 had posterior urethral valve following resection, 1 had epispadias and 1 had urogenital sinus. The average maximum reflux grade was IV. An average of 1.1 cc (range 0.4 to 2) was injected per ureter. Of the patients 69 had 3-month followup results. The overall success rate was 68% after 1 implantation (47 of 69). Conclusions: Submucosal intraureteral implantation with Dx/HA corrected complex vesicoureteral reflux in 68% of patients. In all of these patients open surgery would have potentially been difficult. The use of fluoroscopy and/or guidewires is a useful adjunct in these cases. We believe that this minimally invasive approach is warranted as an initial step in the management of complex cases of VUR before resorting to more difficult open surgical procedures. References 1 : Medical versus surgical treatment in children with severe bilateral vesicoureteric reflux and bilateral nephropathy: a randomised trial. Lancet2001; 357: 1329. Google Scholar 2 : Vesico-ureteric reflux: occurrence and long-term risks. Acta Paediatr1999; 88: 22. 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Google Scholar From the Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia (MP-B, AJK, HCS), Columbia-Presbyterian Medical Center, New York, New York (TWH), and The Children's Hospital, University of Colorado School of Medicine, Denver, Colorado (MAK, PF)© 2004 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byHunziker M, Mohanan N and Puri P (2012) Dextranomer/Hyaluronic Acid Endoscopic Injection is Effective in the Treatment of Intermediate and High Grade Vesicoureteral Reflux in Patients with Complete Duplex SystemsJournal of Urology, VOL. 189, NO. 5, (1876-1881), Online publication date: 1-May-2013.Polackwich A, Skoog S and Austin J (2012) Long-Term Followup After Endoscopic Treatment of Vesicoureteral Reflux with Dextranomer/Hyaluronic Acid Copolymer in Patients with Neurogenic BladderJournal of Urology, VOL. 188, NO. 4S, (1511-1515), Online publication date: 1-Oct-2012.Bar-Yosef Y, Castellan M, Joshi D, Labbie A and Gosalbez R (2011) Salvage Dextranomer-Hyaluronic Acid Copolymer for Persistent Reflux After Ureteral Reimplantation: Early Success RatesJournal of Urology, VOL. 185, NO. 6S, (2531-2535), Online publication date: 1-Jun-2011.Ormaechea M, Ruiz E, Denes E, Gimenez F, Dénes F, Moldes J, Amarante A, Pioner G, Dekermacher S and de Badiola F (2009) New Tissue Bulking Agent (Polyacrylate Polyalcohol) for Treating Vesicoureteral Reflux: Preliminary Results in ChildrenJournal of Urology, VOL. 183, NO. 2, (714-718), Online publication date: 1-Feb-2010.Saperston K, Smith J, Putman S, Matern R, Foot L, Wallis C, deVries C, Snow B and Cartwright P (2008) Endoscopic Subureteral Injection is Not Less Expensive Than Outpatient Open Reimplantation for Unilateral Vesicoureteral RefluxJournal of Urology, VOL. 180, NO. 4S, (1626-1630), Online publication date: 1-Oct-2008.Ashley R and Vandersteen D (2008) Outcome Analysis of Mini-Ureteroneocystostomy Versus Dextranomer/Hyaluronic Acid Copolymer Injection for Unilateral Vesicoureteral RefluxJournal of Urology, VOL. 180, NO. 4S, (1611-1614), Online publication date: 1-Oct-2008.Lewis J, Cheng E, Campbell J, Kropp B, Liu D, Kropp K and Kaplan W (2008) Complete Excision or Marsupialization of Ureteroceles: Does Choice of Surgical Approach Affect Outcome?Journal of Urology, VOL. 180, NO. 4S, (1819-1823), Online publication date: 1-Oct-2008.Cerwinka W, Scherz H and Kirsch A (2007) Endoscopic Treatment of Vesicoureteral Reflux Associated With Paraureteral Diverticula in ChildrenJournal of Urology, VOL. 178, NO. 4, (1469-1473), Online publication date: 1-Oct-2007.Chertin B, Mohanan N, Farkas A and Puri P (2007) Endoscopic Treatment of Vesicoureteral Reflux Associated With UreteroceleJournal of Urology, VOL. 178, NO. 4S, (1594-1597), Online publication date: 1-Oct-2007.McMann L, Scherz H and Kirsch A (2018) Long-Term Preservation of Dextranomer/Hyaluronic Acid Copolymer Implants After Endoscopic Treatment of Vesicoureteral Reflux in Children: A Sonographic Volumetric AnalysisJournal of Urology, VOL. 177, NO. 1, (316-320), Online publication date: 1-Jan-2007.Jung C, DeMarco R, Lowrance W, Pope J, Adams M, Dietrich M and Brock J (2018) Subureteral Injection of Dextranomer/Hyaluronic Acid Copolymer for Persistent Vesicoureteral Reflux Following UreteroneocystostomyJournal of Urology, VOL. 177, NO. 1, (312-315), Online publication date: 1-Jan-2007.Okeke Z, Fromer D, Katz M, Reiley E and Hensle T (2018) Endoscopic Management of Vesicoureteral Reflux in Women Presenting With PyelonephritisJournal of Urology, VOL. 176, NO. 5, (2219-2221), Online publication date: 1-Nov-2006.Lendvay T, Sorensen M, Cowan C, Joyner B, Mitchell M and Grady R (2018) The Evolution of Vesicoureteral Reflux Management in the Era of Dextranomer/Hyaluronic Acid Copolymer: A Pediatric Health Information System Database StudyJournal of Urology, VOL. 176, NO. 4S, (1864-1867), Online publication date: 1-Oct-2006.Kitchens D, Minevich E, DeFoor W, Reddy P, Wacksman J, Sheldon C and Koyle M (2018) Endoscopic Injection of Dextranomer/Hyaluronic Acid Copolymer to Correct Vesicoureteral Reflux Following Failed UreteroneocystostomyJournal of Urology, VOL. 176, NO. 4S, (1861-1863), Online publication date: 1-Oct-2006.Lorenzo A, Salle J, Barroso U, Cook A, Grober E, Wallis M, Bägli D and Khoury A (2018) What are the Most Powerful Determinants of Endoscopic Vesicoureteral Reflux Correction? Multivariate Analysis of a Single Institution Experience During 6 YearsJournal of Urology, VOL. 176, NO. 4S, (1851-1855), Online publication date: 1-Oct-2006.Routh J, Vandersteen D, Pfefferle H, Wolpert J and Reinberg Y (2018) Single Center Experience With Endoscopic Management of Vesicoureteral Reflux in ChildrenJournal of Urology, VOL. 175, NO. 5, (1889-1893), Online publication date: 1-May-2006.Kryger J and Mevorach R (2018) Editorial commentsJournal of Urology, VOL. 175, NO. 4, (1483-1484), Online publication date: 1-Apr-2006.Elder J, Diaz M, Caldamone A, Cendron M, Greenfield S, Hurwitz R, Kirsch A, Koyle M, Pope J and Shapiro E (2018) Endoscopic Therapy for Vesicoureteral Reflux: A Meta-Analysis. I. Reflux Resolution and Urinary Tract InfectionJournal of Urology, VOL. 175, NO. 2, (716-722), Online publication date: 1-Feb-2006. Volume 172Issue 4 Part 2October 2004Page: 1614-1616 Advertisement Copyright & Permissions© 2004 by American Urological Association, Inc.Keywordsvesico-ureteral refluxhyaluronic acidMetricsAuthor Information MARCOS PEREZ-BRAYFIELD More articles by this author ANDREW J. KIRSCH Financial interest and/or other relationship with Q-Med More articles by this author TERRY W. HENSLE Financial interest and/or other relationship with Q-Med More articles by this author MARTIN A. KOYLE Financial interest and/or other relationship with Bayer, Mentor, Q-Med, Alza and Cook More articles by this author PETER FURNESS Financial interest and/or other relationship with Q-Med More articles by this author HAL C. SCHERZ More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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