Role of periureteral injections in children with vesicoureteral reflux.
OBJECTIVE
Periureteral injection has become an increasingly popular method for managing vesicoureteral reflux in children. This minimally invasive and seemingly effective technique, completed in a simple manner, is attracting more attention from urologists and parents alike. This review describes the contemporary experience with injection therapy and attempts to define its place in the algorithm for the management of vesicoureteral reflux.


RESULTS
A variety of different substances have been tried as bulking agents to eliminate vesicoureteral reflux since the technique was introduced more than 20 years ago. Long-term follow-up has found drawbacks with each substance tried. Dextranomer polysaccharide microspheres crosslinked in sodium hyaluronan (Deflux; Ixion Biotechnology, Inc, Alachua, Florida, USA) have recently appeared as another alternative in treatment. Recent reports have focused on the efficacy of the material used in patients with different grades of reflux and in patients whose reflux is associated with other conditions. The substance has performed reasonably well in most initial studies but its cure rates do not approximate those of open surgery. Technical improvements and risk factors for failure are gradually being identified that are aimed at improving performance. The long-term efficacy of Deflux is not well defined and cost-analysis data of patients managed in a prospective randomized fashion are lacking.


CONCLUSIONS
The role of periureteral injection therapy, for patients whose vesicoureteral reflux requires correction, remains unclear. Further studies are needed to elucidate its place in the algorithm for the management of this common problem in children.
Keating
Michael A
MA
Department of Urology, University of South Florida School of Medicine, Tampa, USA. MKeating@nemours.org
D002648:Child; D002675:Child, Preschool; D003558:Cystoscopy; D003911:Dextrans / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D007223:Infant; D015552:Injections, Intralesional; D008297:Male; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014513:Ureter / Q000187:drug effects*; D018666:Ureteroscopy / Q000379:methods; D014563:Urodynamics; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis* / Q000628:therapy*
D003911:Dextrans; C094535:deflux; D006820:Hyaluronic Acid