The evolution of vesicoureteral reflux management in the era of dextranomer/hyaluronic acid copolymer: a pediatric health information system database study.
OBJECTIVE
Since Food and Drug Administration approval of Deflux, injection therapy for vesicoureteral reflux has increased. Little data exist on the effect that injection therapy has had on the incidence of ureteral reimplantation and total vesicoureteral reflux procedures. We used the Pediatric Health Information System database to define practice trends for vesicoureteral reflux therapy.


METHODS
From 2002 to 2004 we extracted data on 0 to 19-year-old patients with International Classification of Diseases-9 diagnosis codes for vesicoureteral reflux, and procedure codes for ureteral reimplantation and subureteral injection therapy. Of 37 hospitals enrolled in Pediatric Health Information System 18 submitted ambulatory surgery and inpatient data. Data on the total number of patients who underwent reimplantation and injection were analyzed using linear regression analysis for trend.


RESULTS
We identified a total of 4,570 procedures performed in 1,948 patients treated with injection therapy and in 2,483 treated with reimplantation. The mean number of injections per institution yearly increased from 17 to 66 from 2002 to 2004 or 288%, while the mean number of reimplantations yearly was not statistically different from 2002 to 2004 (p = 0.02 and 0.09, respectively). In addition, the annual mean number of vesicoureteral reflux procedures per institution increased from 75 to 116 or 55% (p <0.05), primarily due to the increased number of injections.


CONCLUSIONS
With the introduction of a new, minimally invasive procedure for reflux therapy the number of procedures for reflux has increased, while open surgery rates have remained stable. This may be explained by public and clinician acceptance of a newer injection material that is safe and increasingly successful. To our knowledge this represents the largest series of patients treated for vesicoureteral reflux in the United States.
Lendvay
Thomas S
TS
Division of Pediatric Urology and Department of Pediatric Medicine, University of Washington Children's Hospital and Regional Medical Center, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA. thomas.lendvay@seattlechildrens.org
Sorensen
Mathew
M
Cowan
Charles A
CA
Joyner
Byron D
BD
Mitchell
Michael M
MM
Grady
Richard W
RW
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D003911:Dextrans / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007223:Infant; D007267:Injections; D008297:Male; D014513:Ureter; D014718:Vesico-Ureteral Reflux / Q000628:therapy*
D003911:Dextrans; C094535:deflux; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid