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• W2792664691 abstract "No AccessJournal of UrologyPediatric Urology1 Sep 2018Endoscopic Injection of Dextranomer/Hyaluronic Acid as First Line Treatment in 851 Consecutive Children with High Grade Vesicoureteral Reflux: Efficacy and Long-Term Results Florian Friedmacher, Eric Colhoun, and Prem Puri Florian FriedmacherFlorian Friedmacher National Children’s Hospital, Tallaght, Ireland National Children’s Research Center, Our Lady’s Children’s Hospital, Crumlin, Ireland More articles by this author , Eric ColhounEric Colhoun National Children’s Hospital, Tallaght, Ireland More articles by this author , and Prem PuriPrem Puri National Children’s Hospital, Tallaght, Ireland National Children’s Research Center, Our Lady’s Children’s Hospital, Crumlin, Ireland Conway Institute of Biomolecular and Biomedical Research, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.03.074AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Endoscopic injection of dextranomer/hyaluronic acid is widely acknowledged as first line treatment of lower grade vesicoureteral reflux. We demonstrate its long-term efficacy and safety in eradicating high grade reflux. Materials and Methods: A total of 518 girls and 333 boys with a median age of 2.3 years (range 2 months to 13.7 years) underwent endoscopic correction of high grade vesicoureteral reflux using dextranomer/hyaluronic acid. Reflux was unilateral in 415 cases and bilateral in 436, comprising 1,287 refluxing units. Reflux was grade IV in 1,153 ureters (89.6%) and grade V in 134 (10.4%). 99mTechnetium-dimercaptosuccinic acid scintigraphy identified renal scarring in 317 patients (37.3%). Followup ultrasound and voiding cystourethrogram were performed 3 months after intervention and renal ultrasound yearly thereafter. Median followup was 8.5 years (range 6 months to 16 years). Results: Overall resolution rate after the first endoscopic injection was 69.5% (895 of 1,287 cases), with resolution in 70.4% of grade IV and 61.9% of grade V cases. Reflux resolved after a second injection in 259 cases (20.1%) and after a third injection in 133 (10.4%). Persistent reflux after initial treatment was significantly more common in patients younger than age 1 year and in individuals with renal scarring. No significant postoperative complications were observed and no patient required ureteral reimplantation. Following reflux resolution febrile urinary tract infection developed in 43 children (5.1%), including 24 (55.8%) during the first year, 15 (34.9%) during the second year and 4 (9.3%) during year 3 or later. Of these patients 6 had reflux recurrence and 8 had neocontralateral grade III reflux, which was successfully treated with a single endoscopic injection of dextranomer/hyaluronic acid. Conclusions: Endoscopic injection of dextranomer/hyaluronic acid is an efficient and safe long-term treatment for grade IV and V vesicoureteral reflux, and can easily be repeated in patients with treatment failure with a high subsequent resolution rate. References 1 : Vesicoureteral reflux. J Am Soc Nephrol2008; 19: 847. Google Scholar 2 : What is the normal prevalence of vesicoureteral reflux?. Pediatr Radiol2000; 30: 587. Google Scholar 3 : Relationship among vesicoureteral reflux, urinary tract infection and renal damage in children. J Urol2007; 178: 647. Link, Google Scholar 4 : Vesicoureteral reflux associated renal damage: congenital reflux nephropathy and acquired renal scarring. J Urol2010; 184: 265. Link, Google Scholar 5 : The Swedish reflux trial in children: IV. Renal damage. J Urol2010; 184: 292. Link, Google Scholar 6 : Endoscopic treatment of primary vesicoureteral reflux. N Engl J Med2012; 366: 1218. 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Link, Google Scholar 20 : Risk factors for urinary tract infection after dextranomer/hyaluronic acid endoscopic injection. J Urol2009; 182: 1708. Link, Google Scholar 21 : Incidence of urinary tract infections in children after successful ureteral reimplantation versus endoscopic dextranomer/hyaluronic acid implantation. J Urol2008; 179: 2364. Link, Google Scholar 22 : Part 3: endoscopic injection versus antibiotic prophylaxis in the reduction of urinary tract infections in patients with vesicoureteral reflux. Curr Med Res Opin2007; 23: S15. Google Scholar 23 : Renal scarring and urinary tract infection after successful endoscopic correction of vesicoureteral reflux. J Urol2009; 182: 1703. Link, Google Scholar 24 : Prevalence and predictors of renal functional abnormalities of high grade vesicoureteral reflux. J Urol2013; 190: 1490. Link, Google Scholar © 2018 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byRouth J (2018) Endoscopic Therapy for High Grade Vesicoureteral Reflux—First Line Therapy or Too Good to be True?Journal of Urology, VOL. 200, NO. 3, (510-511), Online publication date: 1-Sep-2018.Wan J (2018) This Month in Pediatric UrologyJournal of Urology, VOL. 200, NO. 3, (470-470), Online publication date: 1-Sep-2018. Volume 200Issue 3September 2018Page: 650-655 Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.Keywordsdefluxureterdextranomer-hyaluronic acid copolymervesico-ureteral refluxendoscopyMetricsAuthor Information Florian Friedmacher National Children’s Hospital, Tallaght, Ireland National Children’s Research Center, Our Lady’s Children’s Hospital, Crumlin, Ireland More articles by this author Eric Colhoun National Children’s Hospital, Tallaght, Ireland More articles by this author Prem Puri National Children’s Hospital, Tallaght, Ireland National Children’s Research Center, Our Lady’s Children’s Hospital, Crumlin, Ireland Conway Institute of Biomolecular and Biomedical Research, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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