title: Subureteral dextranomer/hyaluronic acid injection as first line treatment in the management of high grade vesicoureteral reflux.
abstract: OBJECTIVE
  Endoscopic correction of vesicoureteral reflux has become an established alternative to long-term antibiotic prophylaxis and ureteral reimplantation. A number of tissue augmenting substances have been used for the endoscopic correction of vesicoureteral reflux. We prospectively evaluated the effectiveness of dextranomer/hyaluronic acid copolymer (Deflux) as first line treatment for high grade vesicoureteral reflux.
  
  
  METHODS
  Between 2001 and 2004, 692 children with a median age of 2.1 years (3 months to 13.7 years) with high grade vesicoureteral reflux underwent endoscopic subureteral injection of Deflux soon after the diagnosis of vesicoureteral reflux was made on the initial voiding cystourethrogram. Vesicoureteral reflux was unilateral in 283 patients and bilateral in 409. Of the 1,101 ureters vesicoureteral reflux was grade II to V in 35 (3.2%), 580 (52.7%), 457 (41.5%) and 29 (2.6%), respectively. The procedure was performed on an outpatient basis. Followup ultrasound and voiding cystourethrogram were performed 3 months after the procedure, and renal and bladder ultrasound was done annually.
  
  
  RESULTS
  Reflux resolved after first, second and third endoscopic Deflux injections in 952 (86.5%), 130 (11.8%) and 19 ureters (1.7%), respectively. Followup ultrasound revealed no evidence of delayed vesicoureteral junction obstruction. Of the patients 18 (2.6%) had urinary tract infection during followup after successful vesicoureteral reflux correction.
  
  
  CONCLUSIONS
  Endoscopic subureteral injection of Deflux is excellent first line treatment in children with high grade vesicoureteral reflux. This 15-minute outpatient procedure is safe and simple to perform, and it can be easily repeated in failed cases.
authors.affiliation: National Children's Hospital, and Children's Research Centre, Our Lady's Hospital for Sick Children, University College Dublin, Crumlin, Dublin 2, Ireland. prem.puri@ucd.ie
authors.forename: Prem
authors.initials: P
authors.lastname: Puri
authors.forename: Martina
authors.initials: M
authors.lastname: Pirker
authors.forename: Nochiparambil
authors.initials: N
authors.lastname: Mohanan
authors.forename: Michal
authors.initials: M
authors.lastname: Dawrant
authors.forename: Laxman
authors.initials: L
authors.lastname: Dass
authors.forename: Eric
authors.initials: E
authors.lastname: Colhoun
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003911:Dextrans / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007223:Infant; D007267:Injections; D008297:Male; D014513:Ureter; D018666:Ureteroscopy; D014718:Vesico-Ureteral Reflux / Q000628:therapy*
chemical_list: D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid