Bladder ultrasound in the evaluation of the efficacy of dextranomer/hyaluronic acid injection for treatment of vesicoureteral reflux.
OBJECTIVE
To determine whether sonographic examination of subureteral implants after endoscopic dextranomer/hyaluronic acid (DHA) injection would help to evaluate the efficacy of this method in the treatment of vesicoureteral reflux.


METHODS
Thirty-six patients (49 ureters) who underwent endoscopic subureteral DHA injection were evaluated using voiding cystourethrography (VCUG) and bladder sonography for a mean duration of 2.1 years (range, 3 months to 6.5 years) after treatment. Patient records-including the results of VCUG, renal sonography, Dimercapto succinic acid (DMSA) scintigraphy, and periodic urinary analysis-were also reviewed to determine the outcome of treatment.


RESULTS
Reflux was corrected in 43/49 (88%) ureters (complete cure in 38, downgrading of reflux in 5). No change was noted in 6 (12%) ureters on VCUG. The reflux was found to be corrected in 19/22 (86%) ureters, with the implants clearly identifiable on sonography. However, reflux was documented in only 3/27 (11%) ureters, around which no implant was seen on sonography.


CONCLUSIONS
The identification of the implant in the subureteral region by bladder sonography correlated with resolution of reflux in the early postinjection period. On the other hand, the majority of the implants disappeared on sonography in the long term despite correction of reflux. Therefore, we believe that the use of bladder sonography is not useful in the evaluation of patients in long-term follow-up.
Ozcan
Coşkun
C
Department of Pediatric Urology, Ege University, Faculty of Medicine, 35100 Izmir, Turkey.
Ergün
Raziye
R
Ozbek
Süha Süreyya
SS
Avanoğlu
Ali
A
Ulman
Ibrahim
I
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003911:Dextrans / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D007223:Infant; D007267:Injections; D008297:Male; D019736:Prostheses and Implants; D013997:Time Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D001743:Urinary Bladder / Q000000981:diagnostic imaging*; D014718:Vesico-Ureteral Reflux / Q000188:drug therapy*
D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid