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• W2154303478 abstract "No AccessJournal of UrologyPediatric urology1 Dec 2006Lack of Usefulness of Positioned Instillation of Contrast Cystogram After Injection of Dextranomer/Hyaluronic Acid Kirk J. Pinto, Jeff Pugach, and James Saalfield Kirk J. PintoKirk J. Pinto More articles by this author , Jeff PugachJeff Pugach More articles by this author , and James SaalfieldJames Saalfield More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2006.08.051AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Positioned instillation of contrast cystograms have been touted as possibly being more sensitive than standard cystograms for evaluation of vesicoureteral reflux. We performed positioned instillation of contrast cystograms intraoperatively, immediately after the injection of dextranomer/hyaluronic acid to treat vesicoureteral reflux, to determine whether they might be predictive of operative success and obviate the need for the standard postoperative voiding cystourethrogram, which is usually performed at 3 months. Materials and Methods: Patients with vesicoureteral reflux and no confounding conditions were treated with dextranomer/hyaluronic acid and subsequent positioned instillation of contrast cystogram while under the same anesthesia between November 2003 and March 2005. The results of this intraoperative cystogram were compared to the results of the postoperative voiding cystourethrogram performed 3 to 4 months later. Results: A total of 61 patients met the inclusion criteria and underwent positioned instillation of contrast cystogram after dextranomer/hyaluronic acid injection. Only 53 patients (86 ureters) completed the necessary postoperative evaluation. Positioned instillation of contrast cystogram added 4 minutes to the procedure and required about 4 seconds of fluoroscopy per ureter evaluated. The overall success rate for correcting reflux was 84% (72 of 86 ureters cured). None of the 14 ureters with persistent postoperative reflux was identified by intraoperative cystogram, and 3 patients were misidentified as having reflux despite cure confirmed postoperatively. Intraoperative positioned instillation of contrast cystogram was predictive of treatment failure 0% of the time (sensitivity 0%). There were no complications. Conclusions: Positioned instillation of contrast cystogram performed immediately after injection of dextranomer/hyaluronic acid was not useful in predicting which patients would have persistent reflux postoperatively. Patients are best served with the extant protocol of conventional cystography 3 to 4 months postoperatively. References 1 : Treatment of vesicoureteric reflux by endoscopic injection of Teflon. Br Med J1984; 289: 7. Google Scholar 2 : Polytetrafluoroethylene giant granuloma and adenopathy: long-term complications following subureteral polytetrafluoroethylene injection for the treatment of vesicoureteral reflux in children. J Urol1997; 158: 1539. Link, Google Scholar 3 : Failure of subureteral bovine collagen injection for the endoscopic treatment of primary vesicoureteral reflux in long-term follow-up. Urology2000; 55: 759. Google Scholar 4 : Association between bovine collagen dermal implants and a dermatomyositis or polymyositis-like syndrome. Ann Intern Med1993; 118: 920. Google Scholar 5 : Minimally invasive treatment of vesicoureteral reflux with endoscopic injection of dextranomer/hyaluronic acid copolymer: the Children’s Hospital of Atlanta experience. J Urol2003; 170: 211. Link, Google Scholar 6 : Comparison of voiding cystourethrography and expression cystourethrography. J Urol1971; 106: 414. Link, Google Scholar 7 : The PIC cystogram: a novel approach to identify “occult” reflux in children with febrile urinary tract infections. J Urol2003; 169: 2339. Link, Google Scholar 8 : Hydrodistention-implantation technique (HIT): a novel endoscopic treatment for VUR in children and adults. Contemp Urol2005; 17: 24. Google Scholar 9 : Injectable dextranomer-based implant: histopathology, volume changes and DNA-analysis. Scand J Urol Nephrol1999; 33: 355. Google Scholar 10 : Dextranomer/hyaluronic acid for vesicoureteral reflux: success rates after initial treatment failure. J Urol2006; 175: 712. Link, Google Scholar Department of Pediatric Urology, Urology Associates of North Texas and Cook Children’s Medical Center, Fort Worth, Texas© 2006 by American Urological AssociationFiguresReferencesRelatedDetailsCited byHidas G, Soltani T, Watts B, Pribish M and Khoury A (2018) Is the Appearance of the Dextranomer/Hyaluronic Acid Mound Predictive of Reflux Resolution?Journal of Urology, VOL. 189, NO. 5, (1882-1885), Online publication date: 1-May-2013.Zamilpa I, Koyle M, Grady R, Joyner B, Shnorhavorian M and Lendvay T (2011) Can we Rely on the Presence of Dextranomer-Hyaluronic Acid Copolymer Mounds on Ultrasound to Predict Vesicoureteral Reflux Resolution After Injection Therapy?Journal of Urology, VOL. 185, NO. 6S, (2536-2541), Online publication date: 1-Jun-2011.Palmer L (2018) The Role of Intraoperative Cystography Following the Injection of Dextranomer/Hyaluronic Acid CopolymerJournal of Urology, VOL. 179, NO. 3, (1118-1121), Online publication date: 1-Mar-2008. Volume 176Issue 6December 2006Page: 2654-2656 Advertisement Copyright & Permissions© 2006 by American Urological AssociationKeywordsurination disordersminimally invasivevesico-ureteral refluxhyaluronic acidsurgical proceduresMetricsAuthor Information Kirk J. Pinto More articles by this author Jeff Pugach More articles by this author James Saalfield More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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