Multivariate analysis of factors predicting success with dextranomer/hyaluronic acid injection for vesicoureteral reflux.
OBJECTIVE
Factors influencing outcomes of dextranomer/hyaluronic acid injection for vesicoureteral reflux remain poorly defined. We performed multivariate analysis of the experience of 1 surgeon (WS).


METHODS
The study group contained 168 patients and 259 refluxing units. Goal of injection was coaptation of the orifice with creation of a volcanic mound. Outcomes were determined by cystography obtained 12 weeks following injection. Intraoperative photographs of mounds were independently reviewed by 2 authors (WS, SY) without knowledge of results, and classified as "satisfactory" or "other." Univariate and multivariate logistic regression analysis was done evaluating influence of gender, age, voiding dysfunction, reflux grade, unilateral vs bilateral reflux, ureteral duplication, orifice laterality, subureteral vs intraureteral injection, volume injected and mound appearance.


RESULTS
A single injection resolved reflux in 70% of patients and 78% of ureters. Additional injection resulted in overall success in 82% of patients and 86% of ureters. Multivariate analysis demonstrated that reflux grade, volume of dextranomer/hyaluronic acid injected and mound appearance correlated with outcomes. A satisfactory mound was achieved in 81% of ureters, of which 87% no longer refluxed.


CONCLUSIONS
The ability to create a satisfactory mound was the most important factor determining success of dextranomer/hyaluronic acid injection. Increasing reflux grade was associated with a decreased likelihood of achieving a volcanic mound, and increasing volume injected suggested difficulty in creating a mound.
Yucel
Selcuk
S
Department of Urology, Pediatric Urology Section, University of Texas Southwestern Medical Center at Dallas and Children's Medical Center Dallas, Dallas, Texas 75235, USA.
Gupta
Amit
A
Snodgrass
Warren
W
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; D015999:Multivariate Analysis; D011379:Prognosis; D012074:Remission Induction; D014718:Vesico-Ureteral Reflux / Q000628:therapy*
D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid