title: Endoscopic treatment with stabilized nonanimal hyaluronic acid/dextranomer gel is effective in vesicoureteral reflux associated with bladder dysfunction.
abstract: OBJECTIVE
  Endoscopic injection of stabilized nonanimal hyaluronic acid/dextranomer gel is an established treatment for vesicoureteral reflux in children. We performed a subgroup analysis to assess this treatment in reflux associated with bladder dysfunction.
  
  
  METHODS
  Of 308 consecutive children treated endoscopically with stabilized nonanimal hyaluronic acid/dextranomer gel for dilating vesicoureteral reflux 54 were observed retrospectively to have bladder dysfunction. Initial followup consisted of voiding cystourethrogram at 3 and 12 months after injection, with positive response defined as reflux grade 0 or I. At 7 to 12 years following treatment patient charts were checked for urinary tract infections and bladder dysfunction, and a followup survey (postal questionnaire) was administered.
  
  
  RESULTS
  A positive response to therapy (cure) was observed in 45 children (83%) after 1 to 3 endoscopic treatments. Concurrently, bladder dysfunction had resolved in 32 patients (59%). After the last stabilized nonanimal hyaluronic acid/dextranomer gel implantation 45 patients (83%) were free of urinary tract infections. Questionnaire results were similar to chart based findings. Stabilized nonanimal hyaluronic acid/dextranomer gel implantation was well tolerated, with no associated complications.
  
  
  CONCLUSIONS
  Endoscopic treatment with stabilized nonanimal hyaluronic acid/dextranomer gel appears to be similarly effective in patients with vesicoureteral reflux with and without bladder dysfunction. These data indicate that bladder dysfunction should not be considered a contraindication to endoscopic treatment for reflux.
authors.affiliation: Section of Urology, University Children's Hospital, Uppsala, Sweden. goran.lackgren@surgsci.uu.se
authors.forename: Göran
authors.initials: G
authors.lastname: Läckgren
authors.forename: Erik
authors.initials: E
authors.lastname: Sköldenberg
authors.forename: Arne
authors.initials: A
authors.lastname: Stenberg
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003911:Dextrans / Q000008:administration & dosage*; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D001745:Urinary Bladder Diseases / Q000150:complications* / Q000628:therapy; D014555:Urination Disorders / Q000150:complications* / Q000628:therapy; D014718:Vesico-Ureteral Reflux / Q000150:complications* / Q000628:therapy*
chemical_list: D003911:Dextrans; C496587:NASHA-Dx copolymer; D006820:Hyaluronic Acid