New contralateral vesicoureteral reflux following dextranomer/hyaluronic Acid implantation: incidence and identification of a high risk group.
OBJECTIVE
To our knowledge the incidence of NCVUR following the endoscopic treatment of VUR with Dx/HA has not been reported previously. We evaluated the outcomes in a group of patients to determine the incidence, and to attempt to identify risk factors.


METHODS
A total of 126 children with primary unilateral VUR underwent unilateral Dx/HA implantation at our institutions. The incidence of NCVUR was determined by postoperative VCUG. Indications for surgery, patient age and gender, preoperative grade of VUR and volume of Dx/HA injected were assessed as possible risk factors for NCVUR.


RESULTS
Of the patients 96 (76.2%) were female, and mean age was 4.8 years. The principal indications for Dx/HA implantation were persistent reflux in 56 patients (44.4%) and primary therapy in 51 (40.5%). At followup VCUG 17 patients (13.5%) had NCVUR. No variable independently appeared to influence the incidence of NCVUR. Statistical analysis suggests that females younger than 5 years have an increased incidence of NCVUR (13 of 62, or 21% vs 4 of 64, or 6.3% of the remaining patients, p = 0.016).


CONCLUSIONS
NCVUR occurred in approximately 13% of our patients. Patients with higher preoperative VUR grade or a lower number of preoperative VCUGs and those undergoing treatment as primary therapy did not have an increased incidence. Girls younger than 5 years had the highest incidence of NCVUR, and initial bilateral injection may be a consideration for this group. Further effort directed at identifying the etiology and risk factors for NCVUR is needed.
Elmore
James M
JM
Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia 30342, USA.
Kirsch
Andrew J
AJ
Lyles
Robert H
RH
Perez-Brayfield
Marcos R
MR
Scherz
Hal C
HC
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003911:Dextrans / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage; D015994:Incidence; D007223:Infant; D007267:Injections; D008297:Male; D012307:Risk Factors; D014718:Vesico-Ureteral Reflux / Q000453:epidemiology* / Q000628:therapy
D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid