[Endoscopic injection of dextranomer/hyaluronic acid for vesico-ureteral reflux--preliminary results].
BACKGROUND
Endoscopic injection is a minimal invasive treatment for vesico-ureteral reflux, an alternative for prophylactic antibiotics or open surgery. Concerns of safety were raised regarding traditional injectable materials used in the past. The recently introduced dextranomer/hyaluronic acid is a new biocompatable substance. Its safety and efficacy has been investigated and demonstrated.


OBJECTIVE
To report our preliminary results with the endoscopic injection of dextranomer/hyaluronic acid.


METHODS
Twenty nine pediatric patients of mean age 58 months (range 6-144) underwent endoscopic treatment. A total of 42 refluxing ureteral units were treated. Reflux grade was 2, 3, and 4 in 10, 24, and 8, respectively. The procedure was performed under general anesthesia, using a 9.5FR pediatric cystoscope and a semi-rigid needle. The substance was injected submucosally at the 6-o'clock position of the ureteral orifice. A mean of 0.87 ml of the substance was injected (range: 0.6-1.2). In the latter part of the series we injected a minimum of 1 ml for each ureter. During follow-up, ultrasonography and a voiding cystography were performed after 1 and 3 months respectively.


RESULTS
Vesico-ureteral reflux resolved in 32/42 (76%) of the ureters. The rate of success was 10/10 (100%), 19/24 (79%) and 4/8 (50%) in reflux grades 2, 3, and 4, respectively. De-novo contralateral reflux was noted in 5 patients. A single complication occurred: acute venous bleeding originating in the injection site, which was managed endoscopically.


CONCLUSIONS
Endoscopic injection of dextranomer/ hyaluronic acid is a safe and effective treatment. We recommend the injection of 1 ml, the entire volume available for each ureter.
Bar-Yosef
Yuval
Y
Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University. yuvalbary@hotmail.com
Binyamini
Joseph
J
Sofer
Mario
M
Matzkin
Haim
H
Ben-Chaim
Jacob
J
D002648:Child; D002675:Child, Preschool; D003911:Dextrans / Q000008:administration & dosage / Q000627:therapeutic use*; D004724:Endoscopy; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D007223:Infant; D007267:Injections / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D014718:Vesico-Ureteral Reflux / Q000628:therapy*
D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid