The long term result and efficacy of endoscopic treatment of vesicoureteric reflux using dextranomer / hyaluronic acid: Over 15-year experience in a single-center

Abstract

Introduction & Objectives: To evaluate long-term result and efficacy of endoscopic dextranomer/hyaluronic acid (Dx/HA) injection in treating primary-vesicoureteric-reflux (VUR), in terms of resolution of reflux and recurrence of febrile urinary tract infection (fUTI).

Materials & Methods: Since 2006, 131 children (65 boys and 66 girls) with a median age of 5.1 years (range 6 month to 15.0 years) underwent endoscopic subureteral injection of Dx/HA. Sixty-seven children had bilateral reflux and 64 had unilateral reflux, comprising 202 refluxing units. The patients were follow up with ultrasound and voiding cystourethrogram within 6month after injection and renal ultrasound yearly thereafter. The outcomes were assessed by the resolution of VUR and recurrence of fUTI during follow up. Median follow-up was 5.4 years (range 29 months to 12.8 years). This study was approved by the Institutional Review Board of the Korea University Hospital.

Results: Overall resolution rate by ureter was 74.7 % (148 of 198 refluxing ureters) after first endoscopic injection. The resolution rates depending on reflux grade were presented in Figure 1. Thirty-one (23.3%), nine (6.8%) and two (1.5%) patients received 2, 3, and 4 injections, respectively. The resolution was achieved after a second injection in 27 (64.3%) patients and after third injection in 7 (63.6%). Among 5 patients who persisted high grade VUR after several injections, 3 patients underwent ureteral reimplantation and 2 patients refused to receive any treatments. The fUTI was developed in 12 patients (9.2%). Of these patients 5 had reflux recurrence, which was treated with repeated Dx/HA injection. All fUTI episode was occurred within the first 3 years of follow up.

Conclusions: The long term results shows endoscopic injection of Dx/HA is efficient and remain stable to prevent develop fUTI in patients with VUR.