title: Subureteral injection of dextranomer/hyaluronic acid copolymer for persistent vesicoureteral reflux following ureteroneocystostomy.
abstract: OBJECTIVE
  We sought to evaluate the use of subureteral dextranomer/hyaluronic acid copolymer injection for persistent vesicoureteral reflux following ureteroneocystostomy.
  
  
  METHODS
  We performed a retrospective review of patients who had undergone dextranomer/hyaluronic acid injection between 2002 and 2005 for persistent vesicoureteral reflux following ureteroneocystostomy. Analysis included evaluation of patient demographics, reflux grades, voiding dysfunction, reflux resolution rates and operative complications. Success was defined as no reflux on voiding cystourethrogram at 1 to 6 months postoperatively.
  
  
  RESULTS
  A total of 12 cases with 14 refluxing ureters were reviewed. Of the 12 patients treated 9 (10 ureters) had adequate followup. Mean followup was 10 months. Seven of 10 ureters (70%) demonstrated resolution of reflux after the initial injection. A second dextranomer/hyaluronic acid injection resulted in complete resolution in 2 of the 3 failed ureters (67%). Resolution in the remaining failed ureter could not be assessed due to insufficient patient followup. In children with adequate followup success was ultimately achieved in 9 of 9 ureters (100%) using up to 2 injections. A comparison of clinical factors between patients with success after the initial injection and those requiring 2 injections showed that the presence of persistent voiding dysfunction was the only parameter that was statistically significant. All patients tolerated the procedure without complications.
  
  
  CONCLUSIONS
  Considering the difficulties inherent in repeat surgery and the high success rate of dextranomer/hyaluronic acid injection in this series, this treatment is an appealing and reasonable option for patients with persistent vesicoureteral reflux following open ureteroneocystostomy.
authors.affiliation: Department of Pediatric Urology, Vanderbilt Children's Hospital, Nashville, Tennessee, USA.
authors.forename: Charlie
authors.initials: C
authors.lastname: Jung
authors.forename: Romano T
authors.initials: RT
authors.lastname: DeMarco
authors.forename: William T
authors.initials: WT
authors.lastname: Lowrance
authors.forename: John C
authors.initials: JC
authors.lastname: Pope
authors.forename: Mark C
authors.initials: MC
authors.lastname: Adams
authors.forename: Mary S
authors.initials: MS
authors.lastname: Dietrich
authors.forename: John W
authors.initials: JW
authors.lastname: Brock
mesh_terms: D002648:Child; D002675:Child, Preschool; D003559:Cystostomy; D003911:Dextrans / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007267:Injections; D008297:Male; D012189:Retrospective Studies; D017211:Treatment Failure; D014513:Ureter / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000601:surgery / Q000628:therapy*
chemical_list: D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid