title: Dextranomer/hyaluronic acid for vesicoureteral reflux: success rates after initial treatment failure.
abstract: OBJECTIVE
  Following Food and Drug Administration approval of Dx/HA there has been increasing interest in the endoscopic management of VUR. Currently, there are few data regarding the success rates of repeat injection. We recently published our success rates for a group of children following initial Dx/HA treatment, and herein report the success rate of a subgroup of children undergoing repeat injection.
  
  
  METHODS
  We queried our database to identify all children undergoing a second Dx/HA injection for the treatment of VUR at our institution. VUR grades as determined by VCUG before and after the second treatment were specifically noted. Success was defined as the complete absence of VUR by VCUG.
  
  
  RESULTS
  A total of 42 children (37 girls and 5 boys) with a mean age of 5 years underwent a second Dx/HA treatment for VUR after initial treatment failure. Complete followup was available for 39 patients (53 ureters). Before the second injection 14 patients had bilateral and 25 had unilateral VUR, with a mean grade of 2.2. A second Dx/HA injection resolved VUR in 35 of 39 patients (90%) and in 47 of 53 ureters (89%). A second injection resolved reflux in 7 of 8 ureters (88%) with grade I, 24 of 26 (92%) with grade II and 16 of 19 (84%) with grade III VUR.
  
  
  CONCLUSIONS
  A second Dx/HA injection for the treatment of VUR persisting after initial endoscopic treatment has a high success rate. This information is useful when counseling parents after initial treatment failure.
authors.affiliation: Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Elmore
authors.forename: Hal C
authors.initials: HC
authors.lastname: Scherz
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kirsch
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003911:Dextrans; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid; D007223:Infant; D008297:Male; D012074:Remission Induction; D017211:Treatment Failure; D014718:Vesico-Ureteral Reflux / Q000628:therapy*
chemical_list: D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid