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• W2062956918 abstract "No AccessJournal of UrologyVesicoureteral reflux II1 Oct 2007Multivariate Comparison of the Efficacy of Intraureteral Versus Subtrigonal Techniques of Dextranomer/Hyaluronic Acid Injection Jonathan C. Routh, Yuri Reinberg, Richard A. Ashley, Brant A. Inman, James J. Wolpert, David R. Vandersteen, Douglas A. Husmann, and Stephen A. Kramer Jonathan C. RouthJonathan C. Routh More articles by this author , Yuri ReinbergYuri Reinberg More articles by this author , Richard A. AshleyRichard A. Ashley More articles by this author , Brant A. InmanBrant A. Inman More articles by this author , James J. WolpertJames J. Wolpert More articles by this author , David R. VandersteenDavid R. Vandersteen More articles by this author , Douglas A. HusmannDouglas A. Husmann Financial interest and/or other relationship with Qmed. More articles by this author , and Stephen A. KramerStephen A. Kramer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2007.03.174AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Numerous factors have been postulated to increase success rates for dextranomer/hyaluronic acid injection for vesicoureteral reflux. Ureteral hydrodistention combined with intraureteral injection reportedly improves injection success rates. We combined the results of 5 pediatric urologists to evaluate the efficacy of this technique compared to that of subtrigonal-only injection in relation to other factors. Materials and Methods: Patients with primary vesicoureteral reflux undergoing dextranomer/hyaluronic acid injection from April 2002 to December 2005 at 2 institutions were eligible. Only patients with primary vesicoureteral reflux were included in the study. Injection success was defined as the complete absence of reflux on followup voiding cystourethrogram or radionuclide cystogram. Predictors of a successful outcome were analyzed statistically with logistic regression. Factors included in our analysis were gender, age, vesicoureteral reflux grade, dysfunctional voiding, amount of injected dextranomer/hyaluronic acid, injection technique (intraureteral vs subureteral) and surgeon. Results: A total of 301 patients (453 ureters) with a median age of 5.5 years met inclusion criteria, of whom 199 (66%) were cured at 3 months of followup. Of the patients 145 (48%) underwent subureteral injection and 156 (52%) underwent ureteral hydrodistention combined with intraureteral injection. On multivariate analysis only vesicoureteral reflux grade (p <0.001) and surgeon (p = 0.01) were significantly predictive of injection success. There was a trend toward significance with ureteral hydrodistention combined with intraureteral injection (p = 0.056). Conclusions: In our multivariate model only vesicoureteral reflux grade and surgeon were independently predictive of injection success in patients with primary, uncomplicated vesicoureteral reflux. There was a trend toward improved results with ureteral hydrodistention combined with intraureteral injection, although this did not achieve statistical significance. References 1 : Pediatric Vesicoureteral Reflux Guidelines Panel summary report on the management of primary vesicoureteral reflux in children. J Urol1997; 157: 1846. Link, Google Scholar 2 : Vesicoureteral reflux: a new treatment algorithm. Curr Urol Rep2002; 3: 107. Google Scholar 3 : Minimally invasive treatment of vesicoureteral reflux with endoscopic injection of dextranomer/hyaluronic acid copolymer: the Children’s Hospitals of Atlanta experience. J Urol2003; 170: 211. Link, Google Scholar 4 : Subureteral injection of Deflux for correction of reflux: analysis of factors predicting success. Urology2005; 65: 564. Google Scholar 5 : Treatment of vesicoureteral reflux by endoscopic injection of dextranomer/hyaluronic acid copolymer: preliminary results. J Urol2003; 170: 1541. Link, Google Scholar 6 : Single-center experience with endoscopic management of vesicoureteral reflux in children. J Urol2006; 175: 1898. Google Scholar 7 : Long-term followup of children treated with dextranomer/hyaluronic acid copolymer for vesicoureteral reflux. J Urol2001; 166: 1887. Link, Google Scholar 8 : The modified STING procedure to correct vesicoureteral reflux: improved results with submucosal implantation within the intramural ureter. J Urol2004; 171: 2413. Link, Google Scholar 9 : A new bioimplant for the endoscopic treatment of vesicoureteral reflux: experimental and short-term clinical results. J Urol1995; 154: 800. Link, Google Scholar 10 : Endoscopic therapy for vesicoureteral reflux: a meta-analysis: I. Reflux resolution and urinary tract infection. J Urol2006; 175: 716. Link, Google Scholar 11 Kirsch AJ: Intraluminal ureteral injection 2005. Presented at annual meeting of Society for Pediatric Urology, San Antonio, Texas, May 21, 2005. Google Scholar 12 : Dextranomer/hyaluronic acid for vesicoureteral reflux: success rates after initial treatment failure. J Urol2006; 175: 712. Link, Google Scholar 13 : The role of endoscopic treatment of vesicoureteral reflux: a 17-year experience. J Urol2004; 172: 1626. Link, Google Scholar 14 : Prospective comparison and 1-year follow-up of a single endoscopic subureteral polydimethylsiloxane versus dextranomer/hyaluronic acid copolymer injection for treatment of vesicoureteral reflux in children. Urology2002; 60: 894. Google Scholar Department of Urology, Mayo Clinic, Rochester and Division of Urology, Pediatric Surgical Associates (YR, JJW, DRV), Minneapolis, Minnesota© 2007 by American Urological AssociationFiguresReferencesRelatedDetailsCited byLee E, Gatti J, DeMarco R and Murphy J (2009) Long-Term Followup of Dextranomer/Hyaluronic Acid Injection for Vesicoureteral Reflux: Late Failure Warrants Continued FollowupJournal of Urology, VOL. 181, NO. 4, (1869-1875), Online publication date: 1-Apr-2009.Gupta A and Snodgrass W (2008) Intra-Orifice Versus Hydrodistention Implantation Technique in Dextranomer/Hyaluronic Acid Injection for Vesicoureteral RefluxJournal of Urology, VOL. 180, NO. 4S, (1589-1593), Online publication date: 1-Oct-2008. Volume 178Issue 4SOctober 2007Page: 1702-1706 Advertisement Copyright & Permissions© 2007 by American Urological AssociationKeywordsbladderureterhyaluronic acidvesico-ureteral refluxinjectionsAcknowledgmentsHeidi Pfefferle and Sue Rathbun assisted with this study.Metrics Author Information Jonathan C. Routh More articles by this author Yuri Reinberg More articles by this author Richard A. Ashley More articles by this author Brant A. Inman More articles by this author James J. Wolpert More articles by this author David R. Vandersteen More articles by this author Douglas A. Husmann Financial interest and/or other relationship with Qmed. More articles by this author Stephen A. Kramer More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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• W2062956918 title "Multivariate Comparison of the Efficacy of Intraureteral Versus Subtrigonal Techniques of Dextranomer/Hyaluronic Acid Injection" @default.
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