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- W2091069100 abstract "No AccessJournal of UrologyPediatric Urology1 Jul 2012Histology Proved Malpositioning of Dextranomer/Hyaluronic Acid in Submucosal Ureter in Patients After Failed Endoscopic Treatment of Vesicoureteral Reflux David Ben-Meir, Sara Morgenstern, Bezalel Sivan, Rachel Efrat, and Pinhas M. Livne David Ben-MeirDavid Ben-Meir Department of Pediatric Urology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel More articles by this author , Sara MorgensternSara Morgenstern Department of Pathology, Rabin Medical Center, Petach Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel More articles by this author , Bezalel SivanBezalel Sivan Department of Pediatric Urology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel More articles by this author , Rachel EfratRachel Efrat Department of Pediatric Anesthesia, Schneider Children's Medical Center of Israel, Petach Tikva, Israel More articles by this author , and Pinhas M. LivnePinhas M. Livne Department of Pediatric Urology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.03.019AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We histologically investigated the cause of failed endoscopic treatment of vesicoureteral reflux with dextranomer/hyaluronic acid injections in children. Materials and Methods: A total of 192 children underwent dextranomer/hyaluronic acid injection at our institution between January 2008 and September 2010. The study population consisted of 13 children (22 ureters) with vesicoureteral reflux who underwent ureteroneocystostomy following failed endoscopic injections (1 to 2) of dextranomer/hyaluronic acid. In all cases the dextranomer/hyaluronic acid was implanted in the mucosa of the mid to distal ureteral tunnel following hydrodistention of the ureter. The medical records were reviewed, and specimens of the archived distal ureters removed during surgery were examined histologically. Results: Mean patient age was 4.1 years. Mean dose of dextranomer/hyaluronic acid was 0.9 ml (both treatments) and mean lag between treatments was 13.4 months. Indications for open surgery were recurrent urinary tract infections and/or residual or aggravated reflux grade IV or higher. Histological study revealed that the dextranomer/hyaluronic acid was malpositioned in 21 of 22 ureters, residing in the muscle fibers in 2, adventitia in 14 and periureteral space in 5. Conclusions: This is the first known study to provide a histologically proved cause of failure of endoscopic treatment of vesicoureteral reflux with dextranomer/hyaluronic acid injections in children. Malpositioning of the material outside the submucosal ureter was identified in a high percentage of cases. Larger studies are needed to corroborate these findings. References 1 : A new bioimplant for the endoscopic treatment of vesicoureteral reflux: experimental and short-term clinical results. J Urol1995; 154: 800. Link, Google Scholar 2 : The modified STING procedure to correct vesicoureteral reflux: improved results with submucosal implantation within the intramural ureter. J Urol2004; 171: 2413. Link, Google Scholar 3 : Single center experience with endoscopic management of vesicoureteral reflux in children. J Urol2006; 175: 1889. Link, Google Scholar 4 : Long-term followup of dextranomer/hyaluronic acid injection for vesicoureteral reflux: late failure warrants continued followup. J Urol2009; 181: 1869. Link, Google Scholar 5 : Giant cell reaction with phagocytosis adjacent to dextranomer-hyaluronic acid (Deflux) implant: possible reason for Deflux failure. J Pediatr Urol2008; 4: 319. Google Scholar 6 : Influence of voiding dysfunction on the outcome of endoscopic treatment for vesicoureteral reflux. J Urol2002; 168: 1695. Link, Google Scholar 7 : Endoscopic treatment of children with vesico-ureteric reflux. Acta Paediatr Suppl1999; 431: 62. Google Scholar © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 188Issue 1July 2012Page: 258-261 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Keywordsvesico-ureteral refluxdextranomer-hyaluronic acid copolymerureterMetricsAuthor Information David Ben-Meir Department of Pediatric Urology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel More articles by this author Sara Morgenstern Department of Pathology, Rabin Medical Center, Petach Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel More articles by this author Bezalel Sivan Department of Pediatric Urology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel More articles by this author Rachel Efrat Department of Pediatric Anesthesia, Schneider Children's Medical Center of Israel, Petach Tikva, Israel More articles by this author Pinhas M. Livne Department of Pediatric Urology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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- W2091069100 title "Histology Proved Malpositioning of Dextranomer/Hyaluronic Acid in Submucosal Ureter in Patients After Failed Endoscopic Treatment of Vesicoureteral Reflux" @default.
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