Endoscopic Injection of Dextranomer/Hyaluronic Acid Copolymer to Correct Vesicoureteral Reflux Following Failed Ureteroneocystostomy

Purpose. The goal of this review is to present current indications, injectable agents, techniques, success rates, complications, and potential future applications of endoscopic treatment for vesicoureteral reflux (VUR) in children.Materials and Methods. The endoscopic method currently achieving one of the highest success rates is the double hydrodistention-implantation technique (HIT). This method employs dextranomer/hyaluronic acid copolymer, which has been used in pediatric urology for over 10 years and may be at present the first choice injectable agent due to its safety and efficacy.Results. While most contemporary series report cure rates of greater than 85% for primary VUR, success rates of complicated cases of VUR may be, depending on the case, significantly lower. Endoscopic treatment offers major advantages to patients while avoiding potentially complicated open surgery. As the HIT method continues to be applied to complex cases of VUR and more outcome data become available, the indication for endoscopic treatment may exceed the scope of primary VUR.Conclusions. Endoscopic injection is emerging as the treatment of choice for VUR in children.

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766: Cost Analysis of Outpatient Unilateral Extravesical Ureteral Reimplant Versus Endoscopic Injection of Dextronomer/Hyaluronic Acid Copolymer for Unilateral Vesicoureteral Reflux in Children

The Journal of Urology ◽

10.1016/s0022-5347(18)33002-7 ◽

2006 ◽

Vol 175 (4S) ◽

pp. 249-249

Author(s):

James F. Smith ◽

S. Scott Putman ◽

Brent W. Snow ◽

Patrick C. Cartwright ◽

Catherine R. deVries

Keyword(s):

Hyaluronic Acid ◽

Cost Analysis ◽

Vesicoureteral Reflux ◽

Endoscopic Injection ◽

Acid Copolymer

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High-grade vesicoureteral reflux in infants: Our experience with endoscopic subureteric injections

Urologia Journal ◽

10.1177/0391560320966187 ◽

2020 ◽

pp. 039156032096618

Author(s):

Saeed Al Hindi ◽

Mohamed Mubarak ◽

Husain Al Aradi

Keyword(s):

Hyaluronic Acid ◽

Vesicoureteral Reflux ◽

Clinical Laboratory ◽

Symptomatic Relief ◽

Treatment Success ◽

High Grade ◽

Management Options ◽

Endoscopic Injection ◽

Acid Copolymer

Background: Vesicoureteral reflux (VUR) is the most common urological anomaly in pediatric patients. Management options for VUR vary from continuous antibiotic prophylaxis (CAP) to surgery via either endoscopic subureteric injection of a bulking agent or open anti-reflux surgery. In this study, we assess the efficacy of subureteric injections of Dextranomer/Hyaluronic acid Copolymer (Deflux) in managing primary VUR in infant patients with high-grade VUR. Methods: From 2010 to 2015, children less than 1-year-old with primary high-grade VUR were observed prospectively following the administration of endoscopic subureteric injections of Dextranomer/Hyaluronic Acid Copolymer (Deflux). The diagnosis of VUR was based on MCUG, and all patients underwent a holistic clinical, laboratory, and radiological assessment before and after the intervention. Complete success was defined as the resolution of VUR on follow up 1 year post-operatively. Results: A total of 30 infants (50 renal units) with high-grade VUR (grades IV and V) were included in the study. The mean age at surgery was 6.3 ± 2.5 months. Most of the patients presented with a urinary tract infection (90%). Complete symptomatic relief was achieved in 27 patients (90%) at the first post-operative follow-up. Forty-four renal units received one injection, while six required a second injection as they did not meet our treatment success criteria. No patients required a third injection or referral for open surgery. Conclusion: Endoscopic injection of Dextranomer/Hyaluronic acid Copolymer (Deflux) at the vesicoureteral junction is an effective minimally invasive intervention to treat high grades VUR (IV–V) infants.

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